1
|
Dilday J, Leon D, Kuza CM. A review of the utility of high-frequency oscillatory ventilation in burn and trauma ICU patients. Curr Opin Anaesthesiol 2023; 36:126-131. [PMID: 36729001 DOI: 10.1097/aco.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW The purpose was to examine the utility of high-frequency oscillatory ventilation (HFOV) in trauma and burn ICU patients who require mechanical ventilation, and provide recommendations on its use. RECENT FINDINGS HFOV may be beneficial in burn patients with smoke inhalation injury with or without acute lung injury/acute respiratory distress syndrome (ARDS), as it improves oxygenation and minimizes ventilator-induced lung injury. It also may have a role in improving oxygenation in trauma patients with blast lung injury, pulmonary contusions, pneumothorax with massive air leak, and ARDS; however, the mortality benefit is unknown. SUMMARY Although some studies have shown promise and improved outcomes associated with HFOV, we recommend its use as a rescue modality for patients who have failed conventional ventilation.
Collapse
Affiliation(s)
- Joshua Dilday
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - David Leon
- Department of Emergency Medicine, Department of Anesthesia & Critical Care Medicine
| | | |
Collapse
|
2
|
Glas GJ, Horn J, van der Hoeven SM, Hollmann MW, Cleffken B, Colpaert K, Juffermans NP, Knape P, Loef BG, Mackie DP, Malbrain M, Muller J, Reidinga AC, Preckel B, Schultz MJ. Changes in ventilator settings and ventilation-induced lung injury in burn patients-A systematic review. Burns 2019; 46:762-770. [PMID: 31202528 DOI: 10.1016/j.burns.2019.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/20/2019] [Accepted: 05/21/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Ventilation strategies aiming at prevention of ventilator-induced lung injury (VILI), including low tidal volumes (VT) and use of positive end-expiratory pressures (PEEP) are increasingly used in critically ill patients. It is uncertain whether ventilation practices changed in a similar way in burn patients. Our objective was to describe applied ventilator settings and their relation to development of VILI in burn patients. DATA SOURCES Systematic search of the literature in PubMed and EMBASE using MeSH, EMTREE terms and keywords referring to burn or inhalation injury and mechanical ventilation. STUDY SELECTION Studies reporting ventilator settings in adult or pediatric burn or inhalation injury patients receiving mechanical ventilation during the ICU stay. DATA EXTRACTION Two authors independently screened abstracts of identified studies for eligibility and performed data extraction. DATA SYNTHESIS The search identified 35 eligible studies. VT declined from 14 ml/kg in studies performed before to around 8 ml/kg predicted body weight in studies performed after 2006. Low-PEEP levels (<10 cmH2O) were reported in 70% of studies, with no changes over time. Peak inspiratory pressure (PIP) values above 35 cmH2O were frequently reported. Nevertheless, 75% of the studies conducted in the last decade used limited maximum airway pressures (≤35 cmH2O) compared to 45% of studies conducted prior to 2006. Occurrence of barotrauma, reported in 45% of the studies, ranged from 0 to 29%, and was more frequent in patients ventilated with higher compared to lower airway pressures. CONCLUSION This systematic review shows noticeable trends of ventilatory management in burn patients that mirrors those in critically ill non-burn patients. Variability in available ventilator data precluded us from drawing firm conclusions on the association between ventilator settings and the occurrence of VILI in burn patients.
Collapse
Affiliation(s)
- Gerie J Glas
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands; Department of Anesthesiology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands.
| | - Janneke Horn
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands; Department of Intensive Care, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Sophia M van der Hoeven
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands; Department of Intensive Care, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands; Department of Anesthesiology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Berry Cleffken
- Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands
| | - Kirsten Colpaert
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Nicole P Juffermans
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands; Department of Anesthesiology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Paul Knape
- Department of Intensive Care, Red Cross Hospital, Beverwijk, The Netherlands
| | - Bert G Loef
- Department of Intensive Care, Martini Hospital, Groningen, The Netherlands
| | - David P Mackie
- Department of Intensive Care, Red Cross Hospital, Beverwijk, The Netherlands
| | - Manu Malbrain
- Department of Intensive Care, University Hospital Brussels, Jette, Belgium
| | - Jan Muller
- Department of Intensive Care, University Hospital Gasthuisberg, Leuven, Belgium
| | - Auke C Reidinga
- Department of Intensive Care, Martini Hospital, Groningen, The Netherlands
| | - Benedikt Preckel
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands; Department of Anesthesiology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands; Department of Intensive Care, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Oribabor C, Gulkarov I, Khusid F, Ms EF, Esan A, Rizzuto N, Tortolani A, Dattilo PA, Suen K, Ugwu J, Kenney B. The use of high-frequency percussive ventilation after cardiac surgery significantly improves gas exchange without impairment of hemodynamics. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2018; 54:58-61. [PMID: 30996643 PMCID: PMC6422108 DOI: 10.29390/cjrt-2018-013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Respiratory failure represents a significant source of morbidity and mortality for surgical patients. High-frequency percussive ventilation (HFPV) is emerging as a potentially effective rescue therapy in patients failing conventional mechanical ventilation (CMV). Use of HFPV is often limited by concerns for potential effects on hemodynamics, which is particularly tenuous in patients immediately after cardiac surgery. In this manuscript we evaluated the effects of HFPV on gas exchange and cardiac hemodynamics in the immediate postoperative period after cardiac surgery, in comparison with CMV. Methods Twenty-four consecutive cardiac surgery patients were ventilated in immediate postoperative period with HFPV for two to four hours, then they switched to a CMV using the adaptive support ventilation mode for weaning. Arterial blood gases were performed during the first and second hour on HFPV, and at 45 minutes after initiation of CMV. Respiratory settings and invasive hemodynamic data (mixed venous oxygen saturation, central venous pressure, systemic and pulmonary blood pressure, cardiac output and index) were collected utilizing right heart pulmonary catheter and arterial lines during HFPV and CMV. Primary outcome was improvement in the ratio between partial pressure of oxygen to fraction of inspired oxygen (P/F ratio) and changes in hemodynamics. Results Analysis of data for 24 patients revealed a significantly better P/F ratio during the first and second hour on HFPV, compared with a P/F ratio on CMV (420.0 ± 158.8, 459.2 ± 138.5, and 260.2 ± 98.5 respectively, p < 0.05), suggesting much better gas exchange on HFPV than on CMV. Hemodynamics were not affected by the mode of the ventilation. Conclusions Improvement in gas exchange, reflected in a significantly improved P/F ratio, wasn't accompanied by worsening in hemodynamic parameters. The significant gains in the P/F ratio were lost when patients were switched to conventional ventilation. This data suggest that HFPV provides significantly better gas exchange compared with CMV and can be safely utilized in postoperative cardiac patients without any significant effect on hemodynamics.
Collapse
Affiliation(s)
- Charles Oribabor
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, Staten Island University Hospital Staten Island, NY, USA
| | - Felix Khusid
- Department of Respiratory Therapy, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Emma Fischer Ms
- Department of Respiratory Therapy, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Adebayo Esan
- Department of Medicine, Hanover Hospital, Hanover, PA, USA
| | - Nancy Rizzuto
- Department of Nursing, Brooklyn University Hospital and Medical Center, Brooklyn, NY, USA
| | - Anthony Tortolani
- Department of Surgery, Brooklyn University Hospital and Medical Center, Brooklyn, NY, USA
| | - Paris Ayanna Dattilo
- Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Kaki Suen
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Justin Ugwu
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Brent Kenney
- Department of Respiratory Therapy, Mercy Hospital Springfield, Springfield, MO, USA
| |
Collapse
|
4
|
Miller AC, Ferrada PA, Kadri SS, Nataraj-Bhandari K, Vahedian-Azimi A, Quraishi SA. High-Frequency Ventilation Modalities as Salvage Therapy for Smoke Inhalation-Associated Acute Lung Injury: A Systematic Review. J Intensive Care Med 2017. [PMID: 28651475 DOI: 10.1177/0885066617714770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Smoke inhalation-associated acute lung injury (SI-ALI) is a major cause of morbidity and mortality in victims of fire tragedies. To date, there are no evidence-based guidelines on ventilation strategies in acute respiratory distress syndrome (ARDS) after smoke inhalation. We reviewed the existing literature for clinical studies of salvage mechanical ventilation (MV) strategies in patients with SI-ALI, focusing on mortality and pneumonia as outcomes. METHODS A systematic search was designed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk of bias assessment was performed using the Newcastle-Ottawa Quality Assessment Scale (NOS; 0 to 9 stars), with a score ≥7 being the threshold for inclusion in the meta-analysis. A systematic search strategy was used to search 10 databases. Clinical studies were included in which patients: (1) experienced smoke inhalation, (2) treated with MV, and (3) described a concurrent or historical control group. RESULTS A total of 226 potentially relevant studies were identified, of which 7 studies on high-frequency percussive ventilation (HFPV) met inclusion criteria. No studies met inclusion for meta-analysis (NOS ≥ 7). In studies comparing HFPV to conventional mechanical ventilation (CMV), mortality and pneumonia incidence improved in 3 studies and remained unchanged in 3 others. No change in ventilator days or ICU length of stay was observed; however, oxygenation and work of breathing improved with HFPV. CONCLUSIONS Mechanical ventilation in patients with SI-ALI has not been well studied. High-frequency percussive ventilation may decrease in-hospital mortality and pneumonia incidence when compared to CMV. The absence of "good" quality evidence precluded meta-analysis. Based upon low-quality evidence, there was a very weak recommendation that HFPV use may be associated with lower mortality and pneumonia rates in patients with SI-ALI. Given SI-ALI's unique underlying pathophysiology, and its potential implications on therapy, randomized controlled studies are required to ensure that patients receive the safest and most effective care. TRIAL REGISTRATION The study was registered with PROSPERO International prospective register of systematic reviews (#47015).
Collapse
Affiliation(s)
- Andrew C Miller
- 1 Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.,2 Department of Emergency Medicine, West Virginia University, Morgantown, WV, USA
| | - Paula A Ferrada
- 3 Division of Trauma and Critical Care, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Sameer S Kadri
- 1 Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Amir Vahedian-Azimi
- 4 Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sadeq A Quraishi
- 5 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,6 Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Arora S, Singh PM, Trikha A. Ventilatory strategies in trauma patients. J Emerg Trauma Shock 2014; 7:25-31. [PMID: 24550626 PMCID: PMC3912646 DOI: 10.4103/0974-2700.125635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/02/2013] [Indexed: 01/21/2023] Open
Abstract
Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented.
Collapse
Affiliation(s)
- Shubhangi Arora
- Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India
| | - Preet Mohinder Singh
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India
| |
Collapse
|
6
|
NIE FACHUAN, SU DONG, SHI YING, CHEN JINMEI, WANG HAIHUI, QIN WANXIANG, WANG SUXIA, CHEN YAOHUA. Early high volume lung lavage for acute severe smoke inhalation injury in dogs. Mol Med Rep 2013; 9:863-71. [DOI: 10.3892/mmr.2013.1877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 12/11/2013] [Indexed: 11/05/2022] Open
|
7
|
Rojas M, Parker RE, Thorn N, Corredor C, Iyer SS, Bueno M, Mroz L, Cardenes N, Mora AL, Stecenko AA, Brigham KL. Infusion of freshly isolated autologous bone marrow derived mononuclear cells prevents endotoxin-induced lung injury in an ex-vivo perfused swine model. Stem Cell Res Ther 2013; 4:26. [PMID: 23497755 PMCID: PMC3706906 DOI: 10.1186/scrt174] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 03/04/2013] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The acute respiratory distress syndrome (ARDS), affects up to 150,000 patients per year in the United States. We and other groups have demonstrated that bone marrow derived mesenchymal stromal stem cells prevent ARDS induced by systemic and local administration of endotoxin (lipopolysaccharide (LPS)) in mice. METHODS A study was undertaken to determine the effects of the diverse populations of bone marrow derived cells on the pathophysiology of ARDS, using a unique ex-vivo swine preparation, in which only the ventilated lung and the liver are perfused with autologous blood. Six experimental groups were designated as: 1) endotoxin alone, 2) endotoxin + total fresh whole bone marrow nuclear cells (BMC), 3) endotoxin + non-hematopoietic bone marrow cells (CD45 neg), 4) endotoxin + hematopoietic bone marrow cells (CD45 positive), 5) endotoxin + buffy coat and 6) endotoxin + in vitro expanded swine CD45 negative adherent allogeneic bone marrow cells (cultured CD45neg). We measured at different levels the biological consequences of the infusion of the different subsets of cells. The measured parameters were: pulmonary vascular resistance (PVR), gas exchange (PO2), lung edema (lung wet/dry weight), gene expression and serum concentrations of the pro-inflammatory cytokines IL-1β, TNF-α and IL-6. RESULTS Infusion of freshly purified autologous total BMCs, as well as non-hematopoietic CD45(-) bone marrow cells significantly reduced endotoxin-induced pulmonary hypertension and hypoxemia and reduced the lung edema. Also, in the groups that received BMCs and cultured CD45neg we observed a decrease in the levels of IL-1β and TNF-α in plasma. Infusion of hematopoietic CD45(+) bone marrow cells or peripheral blood buffy coat cells did not protect against LPS-induced lung injury. CONCLUSIONS We conclude that infusion of freshly isolated autologous whole bone marrow cells and the subset of non-hematopoietic cells can suppress the acute humoral and physiologic responses induced by endotoxemia by modulating the inflammatory response, mechanisms that do not involve engraftment or trans-differentiation of the cells. These observations may have important implications for the design of future cell therapies for ARDS.
Collapse
|