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American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 801-808, (2002)
© 2002 American Thoracic Society

Original Article

High-Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome in Adults

A Randomized, Controlled Trial

Stephen Derdak, Sangeeta Mehta, Thomas E. Stewart, Terry Smith, Mark Rogers, Timothy G. Buchman, Brian Carlin, Stuart Lowson, John Granton and the Multicenter Oscillatory Ventilation for Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators

Pulmonary/Critical Care Medicine, Wilford Hall Medical Center, San Antonio, Texas; Departments of Medicine, Anaesthesia, Critical Care Medicine, and Trauma, Mt. Sinai Hospital, Sunnybrook and Women's College Health Sciences Center, and University Health Network, University of Toronto, Toronto, Ontario, Canada; Departments of Critical Care Medicine and Respiratory Care, Loma Linda University Medical Center, Loma Linda, California; Division of Surgery, Barnes Jewish Hospital, St. Louis, Missouri; Department of Pulmonary/Critical Care Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania; and Departments of Anesthesia and Critical Care Medicine, University of Virginia Medical Center, Charlottesville, Virginia

Correspondence and requests for reprints should be addressed to Stephen Derdak, D.O., Col. U.S.A.F. M.C., Wilford Hall Medical Center, Pulmonary/Critical Care Medicine (MCCP), Lackland AFB, TX 78236. E-mail: sderdak{at}mac.com

Observational studies of high-frequency oscillatory ventilation in adults with the acute respiratory distress syndrome have demonstrated improvements in oxygenation. We designed a multicenter, randomized, controlled trial comparing the safety and effectiveness of high-frequency oscillatory ventilation with conventional ventilation in adults with acute respiratory distress syndrome; 148 adults with acute respiratory distress syndrome (PaO2/fraction of inspired oxygen <= 200 mm Hg on 10 or more cm H2O positive end-expiratory pressure) were randomized to high-frequency oscillatory ventilation (n = 75) or conventional ventilation (n = 73). Applied mean airway pressure was significantly higher in the high-frequency oscillation group compared with the conventional ventilation group throughout the first 72 hours (p = 0.0001). The high-frequency oscillation group showed early (less than 16 hours) improvement in PaO2/fraction of inspired oxygen compared with the conventional ventilation group (p = 0.008); however, this difference did not persist beyond 24 hours. Oxygenation index decreased similarly over the first 72 hours in both groups. Thirty-day mortality was 37% in the high-frequency oscillation group and was 52% in the conventional ventilation group (p = 0.102). The percentage of patients alive without mechanical ventilation at Day 30 was 36% and 31% in the high-frequency oscillation and conventional ventilation groups, respectively (p = 0.686). There were no significant differences in hemodynamic variables, oxygenation failure, ventilation failure, barotraumas, or mucus plugging between treatment groups. We conclude that high-frequency oscillation is a safe and effective mode of ventilation for the treatment of acute respiratory distress syndrome in adults.

Key Words: acute respiratory distress syndrome • high-frequency ventilation • high-frequency oscillation • mechanical ventilation • oxygenation index




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