Big trials came with no mortality benefits from HFOV in ARDS cases, although bed side management for these patients with HFOV, showed some benefits?
In my Unit, using higher levels of PEEP and recruitment maneuvers in ARDS patients has dramatically decreased the use of HFO. I strongly believe that previously, we have been inadvertingly recruiting our patients with HFO.....so the great advantge showed by HFO was our inappropriate management of conventional ventilator settings. I am not saying HFO is killing now our patients, but I am pretty sure we were killing our patients with mechanical ventilation, so HFO seemed a magical rescue treatment. Perhaps, I am wrong, but I think that alveoli does not care which device and mode are we using to open and keep it opened...if we use it properly.
Marti's remarks ring true. I am very interested, however, in seeing the studies showing how certain modes, particularly APRV, can help to actually PREVENT ARDS from developing (yes, when used properly). Animal models are very promising and we need more human data. Nader Habashi's and Gary Nieman's collaborations look to be very on the cutting edge. Roy S et al "Early airway pressure release ventilation prevents ARDS - a novel preventive approach to lung injury", Shock, Jan 2013;39(1):28-38, provides us with glimpses into ARDS prevention. I highly recommend this and other articles from this group of innovative researchers and clinicians to help us help our patients.
My take on aggressive recruitment strategies including high PEEP and HFO is that they come with a price, namely, the frequent need to support the circulation with fluids and inotropes. Until we get a handle on the risk/benefit of cardiovascular management decision the jury on these modalities is out. The APRV literature is hardly convincing and other than its use as rescue therapy HFO cannot be recommendedat present
Much of the APRV literature is misleading since much of it's use has been misuse. Much like driving a car, it is the drover wjp dictates the success of the care given and the car driven.
I appreciate all these answers but in fact I feel the usage of HFOV still not properly used in adults patients with ARDS for some reasons. I am afraid one of the reasons that we not used more frequently so we don't know exactly the performance of the machine or the patient- relation relation which may need more studies and experience.
HFO can be useful when used in the early phase of ARDS. When used as a rescue!, you may have to use more aggressive HFO ventilator settings. On the other side of the coin is, where does permissive hypercapnia fit in the clinical picture This is bigger problem when patients are fluid positive and then other issues cascade
The second part of your sentence contains much truth. If Oscillatory Ventilation is used without training and without clinical experience it can be harmful. It should not be used without clinical experience for ARDS. Before using oscillatory ventilation in ARDS, you should acquire clinical experience in mild forms of respiratory insufficiency