• Charikleia S Vrettou, Spyros G Zakynthinos, Sotirios Malachias, and Spyros D Mentzelopoulos.
• First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece. Electronic address: vrettou@hotmail.com.
• J Crit Care. 2014 Aug 1;29(4):568-73.

PurposeHigh-frequency oscillation combined with tracheal gas insufflation (HFO-TGI) improves oxygenation in patients with acute respiratory distress syndrome (ARDS). There are limited physiologic data regarding the effects of HFO-TGI on hemodynamics and pulmonary edema during ARDS. The aim of this study was to investigate the effect of HFO-TGI on extravascular lung water (EVLW).Materials And MethodsWe conducted a prospective, randomized, crossover study. Consecutive eligible patients with ARDS received sessions of conventional mechanical ventilation with recruitment maneuvers (RMs), followed by HFO-TGI with RMs, or vice versa. Each ventilatory technique was administered for 8 hours. The order of administration was randomly assigned. Arterial/central venous blood gas analysis and measurement of hemodynamic parameters and EVLW were performed at baseline and after each 8-hour period using the single-indicator thermodilution technique.ResultsTwelve patients received 32 sessions. Pao2/fraction of inspired oxygen and respiratory system compliance were higher (P<.001 for both), whereas extravascular lung water index to predicted body weight and oxygenation index were lower (P=.021 and .029, respectively) in HFO-TGI compared with conventional mechanical ventilation. There was a significant correlation between Pao2/fraction of inspired oxygen improvement and extravascular lung water index drop during HFO-TGI (Rs=-0.452, P=.009).ConclusionsHigh-frequency oscillation combined with tracheal gas insufflation improves gas exchange and lung mechanics in ARDS and potentially attenuates EVLW accumulation.Copyright © 2014 Elsevier Inc. All rights reserved.

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