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High frequency ventilation fails to benefit adults with ARDS

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f445 (Published 05 February 2013) Cite this as: BMJ 2013;346:f445

High frequency oscillatory ventilation delivers very small breaths at very high rates and is designed to protect mechanically ventilated patients from secondary lung damage. Two new trials suggest it works no better—and possibly worse—than standard ventilation protocols for adults with acute respiratory distress syndrome (ARDS), however. A pragmatic trial from the UK reported no reduction in mortality when compared with standard ventilation determined by local protocols. A second, from five countries, reported significantly higher death rates in adults treated with high frequency oscillatory ventilation, relative to controls managed with a modern strategy using low tidal volumes and relatively high positive end expiratory pressure (PEEP). The trial was stopped early (in hospital mortality 47% v 35%; relative risk 1.33, 95% CI 1.09 to 1.64).

In both trials, adults managed with high frequency oscillatory ventilation needed more sedatives and muscle relaxants than controls. They also needed more haemodynamic support than controls in the international trial. Participants had moderate or severe acute respiratory distress syndrome.

These findings overturn earlier smaller trials and put high frequency ventilation on shakier ground, says a linked editorial (doi:10.1056//NEJMe1300103). Research should continue, but the evidence so far doesn’t look strong enough for widespread use in adults with acute respiratory distress syndrome.

Notes

Cite this as: BMJ 2013;346:f445

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