Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

In acute respiratory distress syndrome (ARDS), recruitment sessions of high-frequency oscillation (HFO) and tracheal-gas insufflation (TGI) with short-lasting recruitment maneuvers (RMs) may improve oxygenation, and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome. We conducted a prospective, clinical trial, subdivided in a first, single-center period and a second, two-center period. We enrolled 125 (first period, n=54) patients with P a,O2/inspired O2 fraction (FiO2) 12 consecutive hours at end-expiratory pressure≥8 cmH2O. Patients were randomly assigned to HFO-TGI-group (n=61, receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV) or CMV-group (n=64, receiving lung-protective CMV and RMs). Primary outcome was survival to hospital-discharge. Pre-enrollment ventilation-duration was variable. During days 1-10 post-randomization, P a,O2/FiO2, oxygenation index, plateau-pressure and respiratory compliance were improved in HFO-TGI-group vs. CMV-group (P<0.001 for group*time). Within days 1-60, HFO-TGI-group vs. CMV-group had more ventilator-free days {31.0 (0.0–42.0) vs. 0.0 (0.0–23.0), P<0.001}, and more days without respiratory, circulatory, renal, coagulation, and liver failure (P≤0.003). Survival to hospital-discharge was higher in HFO-TGI-group vs. CMV-group (38/61, 62.3% vs. 23/64, 35.9%, P=0.004). Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS. ClinicalTrials.gov identifiers: First period: [NCT00416260][1]; Second period: [NCT00637507][2]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00416260&atom=%2Ferj%2Fearly%2F2011%2F09%2F01%2F09031936.00158810.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00637507&atom=%2Ferj%2Fearly%2F2011%2F09%2F01%2F09031936.00158810.atom