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Master Thesis

Impact de séances quotidiennes de ventilation par oscillations à haute fréquence dans les SDRA modérés à sévères sur le volume pulmonaire télé-expiratoire, la compliance pulmonaire et l’oxygénation

Abstract : Introduction: High-frequency oscillatory ventilation (HFOV) is usually considered as an alternative continuous technique to conventional mechanical ventilation (CMV) with the aim of improving the oxygenation. Our goal was to use HFOV not as a surrogate to CMV but as a recruitment process during only 6 hours a day alternating with the CMV and to test if this new sequential HFOV use could increase the end-expiratory lung volume (EELV) and the respiratory system compliance (used as recrutment markers) and thus improve the oxygenation. Method: Interventional prospective study, in single-center ICU (Saint Denis de La Reunion University Hospital), performed in patients with moderate to severe ARDS (PaO2/FiO2 ratio <150 after a 6h period of optimized CMV for maximal alveolar recruitment). Patients were placed under HFO sequentially (6h a day) up to four days in a row, as long as PaO2/FIO2 ratio was less than 200. The primary endpoint was the before/after HFO session EELV difference measured by the nitrogen wash in/ wash out technique. Secondary end points were the before/after HFO session PaO2/FiO2 ratio and respiratory system compliance differences. Results: Twenty-two patients (mean IGS 55 ± 14) were enrolled between November 2012 and May 2015 for a total of 29 sessions. Three of these (10%) were stopped (two for hemodynamic failure and one for respiratory failure). After the 6-h HFOV session, the EELV increased significantly by more than 30% while the PaO2/FiO2 ratio and the respiratory system compliance increased significantly by more than 90% and more than 20%, respectively. By considering as responder to the HFOV session a patient with an EELV increase of more than 15% after the HFOV, we obtained 19 responders (66%) for 10 non-responders. By considering as responder to the HFOV session a patient with an EELV increase of more than 15% and a PaO2/FiO2 ratio increase of more than 30% after the HFOV, we obtained 16 responders (55%) for 13 non-responders. No significant change in hemodynamic parameters was found, except the significant 10 ± 6% cardiac index decrease after one hour of HFOV for the 15 sessions monitored by transpulmonary thermodilution. No pneumothorax occurred during the protocol. Conclusion: In ARDS patients with a PaO2 /FiO2 ratio <150, an early 6-h HFOV session provides a significant improvement of oxygenation and ventilatory mechanics by alveolar recruitment. HFOV could be used sequentially in addition to CMV as a recruiting technique and not as an alternative rescue method.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01245908
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Thursday, December 17, 2015 - 6:06:56 PM
Last modification on : Wednesday, August 23, 2017 - 4:41:25 PM
Long-term archiving on: : Friday, March 18, 2016 - 3:11:22 PM

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Bérénice Puech. Impact de séances quotidiennes de ventilation par oscillations à haute fréquence dans les SDRA modérés à sévères sur le volume pulmonaire télé-expiratoire, la compliance pulmonaire et l’oxygénation. Médecine humaine et pathologie. 2015. ⟨dumas-01245908⟩

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