SESSION TITLE: ARDS/Lung Injury Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: High-frequency percussive ventilation (HFPV) is a mode of mechanical ventilation that may be used as an alternative to conventional ventilation (CV) for patients with severe ARDS and refractory hypoxemia. HFPV is a hybrid mode of ventilation combining low-frequency pressure-cycled normal volume convective ventilation with high-frequency low volume pulsatile ventilation. Our center has used HFPV for the past 8 years. There is limited data regarding which patients might derive the optimal benefit, if any, from HFPV. The purpose of our study is to compare characteristics of survivors (S) vs. non-survivors (NS) who received HFPV and identify possible predictors of survival.
METHODS: A retrospective observational study of adult medical, surgical, and burn patients with acute respiratory failure admitted to the ICU between 2005-2013 who had received HFPV. A total of 75 adult patients were identified. 5 patients were excluded due to insufficient available data. A total of 70 patients were analyzed. A Student's t-test was used to examine the mean differences in continuous data between groups while Fisher's exact test using 2x2 contingency tables was used to evaluate differences in categorical data. Survivors were defined as living to hospital discharge. Non-survivors were defined as having expired in the hospital. All data is reported as means (unless otherwise specified) with (standard deviations).
RESULTS: # HFPV survivors-32 # HFPV non-survivors-38 Mortality-54.3% Age (years) S=47.9 (14.0) vs NS=53.4 (14.6) p=0.11 Male (total #) S=25 vs NS=23 p=0.13 APACHE II S=22.1 (7.1) vs NS=29.3 (7.1); overall 26 p <0.001 Sepsis (total #) S=12 vs NS=20 p=0.23 Trauma (total #) S=6 vs NS=5 p=0.74 Burn (total #) S=10 vs NS=5 p=0.08 Pancreatitis N=1; Ischemic Bowel N=1; COP N=2; Acute Liver Failure N=1; Intracerebral Hemorrhage N=2; Ruptured AAA N=2; H1N1 N=1; Unknown N=2 (total #) S=4 vs NS=8 p=0.53 Pre-HFPV Pa02 / Fi02 S=127 (131) vs NS=103 (92) p=0.39 Post-HFPV Pa02 / Fi02 S=164 (113) vs NS=138 (88) p=0.29 Days of CV prior to HFPV S=4.5 (5.7) vs NS=8.4 (13.7) p=0.11
CONCLUSIONS: Overall mortality in our patients treated with HFPV was 54.3%, with a predicted mortality of 52% based on an overall APACHE II score of 26. The only identifiable predictor of mortality was APACHE II score.
CLINICAL IMPLICATIONS: We found a trend in favor of higher survival for patients who were started on HFPV earlier and who had higher P/F ratios prior to HFPV. This observation warrants further study.
DISCLOSURE: The following authors have nothing to disclose: Eduardo Solbes, Halley Tsai, Craig Ivie, Frank Kagawa, Carl Kirsch, Eric Hsiao, Allison Friedenberg, Virginia Chen, Amit Gohil, Vibha Mohindra, John Wehner
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