High-frequency percussive ventilation and low tidal volume ventilation in burns: A randomized controlled trial

Kevin K. Chung, Steven Wolf, Evan M. Renz, Patrick F. Allan, James K. Aden, Gerald A. Merrill, Mehdi C. Shelhamer, Booker T. King, Christopher E. White, David G. Bell, Martin G. Schwacha, Sandra M. Wanek, Charles E. Wade, John B. Holcomb, Lorne H. Blackbourne, Leopoldo C. Cancio

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Objectives: In select burn intensive care units, high-frequency percussive ventilation is preferentially used to provide mechanical ventilation in support of patients with acute lung injury, acute respiratory distress syndrome, and inhalation injury. However, we found an absence of prospective studies comparing high-frequency percussive ventilation with contemporary low-tidal volume ventilation strategies. The purpose of this study was to prospectively compare the two ventilator modalities in a burn intensive care unit setting. Design: Single-center, prospective, randomized, controlled clinical trial, comparing high-frequency percussive ventilation with low-tidal volume ventilation in patients admitted to our burn intensive care unit with respiratory failure. Setting: A 16-bed burn intensive care unit at a tertiary military teaching hospital. Patients: Adult patients ≥18 yrs of age requiring prolonged (>24 hrs) mechanical ventilation were admitted to the burn intensive care unit. The study was conducted over a 3-yr period between April 2006 and May 2009. This trial was registered with ClinicalTrials.gov as NCT00351741. Interventions: Subjects were randomly assigned to receive mechanical ventilation through a high-frequency percussive ventilation-based strategy (n = 31) or a low-tidal volume ventilation-based strategy (n = 31). Measurements and main results: At baseline, both the high-frequency percussive ventilation group and the low-tidal volume ventilation group had similar demographics to include median age (interquartile range) (28 yrs [23-45] vs. 33 yrs [24-46], p = nonsignificant), percentage of total body surface area burn (34 [20-52] vs. 34 [23-50], p = nonsignificant), and clinical diagnosis of inhalation injury (39% vs. 35%, p = nonsignificant). The primary outcome was ventilator-free days in the first 28 days after randomization. Intent-to-treat analysis revealed no significant difference between the high-frequency percussive ventilation and the low-tidal volume ventilation groups in mean (± sd) ventilator-free days (12 ± 9 vs. 11 ± 9, p = nonsignificant). No significant difference was detected between groups for any of the secondary outcome measures to include mortality except the need for "rescue" mode application (p =.02). Nine (29%) in the low-tidal volume ventilation arm did not meet predetermined oxygenation or ventilation goals and required transition to a rescue mode. By contrast, two in the high-frequency percussive ventilation arm (6%) required rescue. Conclusions: A high-frequency percussive ventilation-based strategy resulted in similar clinical outcomes when compared with a low-tidal volume ventilation-based strategy in burn patients with respiratory failure. However, the low-tidal volume ventilation strategy failed to achieve ventilation and oxygenation goals in a higher percentage necessitating rescue ventilation.

Original languageEnglish (US)
Pages (from-to)1970-1977
Number of pages8
JournalCritical Care Medicine
Volume38
Issue number10
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

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High-Frequency Ventilation
Tidal Volume
Burns
Randomized Controlled Trials
Intensive Care Units
Mechanical Ventilators
Artificial Respiration
Ventilation
Respiratory Insufficiency
Inhalation
Military Hospitals
Acute Lung Injury
Body Surface Area
Adult Respiratory Distress Syndrome
Wounds and Injuries
Random Allocation
Tertiary Care Centers
Teaching Hospitals
Demography
Outcome Assessment (Health Care)

Keywords

  • burns
  • high frequency
  • inhalation injury
  • lowtidal volume ventilation
  • percussive ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

High-frequency percussive ventilation and low tidal volume ventilation in burns : A randomized controlled trial. / Chung, Kevin K.; Wolf, Steven; Renz, Evan M.; Allan, Patrick F.; Aden, James K.; Merrill, Gerald A.; Shelhamer, Mehdi C.; King, Booker T.; White, Christopher E.; Bell, David G.; Schwacha, Martin G.; Wanek, Sandra M.; Wade, Charles E.; Holcomb, John B.; Blackbourne, Lorne H.; Cancio, Leopoldo C.

In: Critical Care Medicine, Vol. 38, No. 10, 01.01.2010, p. 1970-1977.

Research output: Contribution to journalArticle

Chung, KK, Wolf, S, Renz, EM, Allan, PF, Aden, JK, Merrill, GA, Shelhamer, MC, King, BT, White, CE, Bell, DG, Schwacha, MG, Wanek, SM, Wade, CE, Holcomb, JB, Blackbourne, LH & Cancio, LC 2010, 'High-frequency percussive ventilation and low tidal volume ventilation in burns: A randomized controlled trial', Critical Care Medicine, vol. 38, no. 10, pp. 1970-1977. https://doi.org/10.1097/CCM.0b013e3181eb9d0b
Chung, Kevin K. ; Wolf, Steven ; Renz, Evan M. ; Allan, Patrick F. ; Aden, James K. ; Merrill, Gerald A. ; Shelhamer, Mehdi C. ; King, Booker T. ; White, Christopher E. ; Bell, David G. ; Schwacha, Martin G. ; Wanek, Sandra M. ; Wade, Charles E. ; Holcomb, John B. ; Blackbourne, Lorne H. ; Cancio, Leopoldo C. / High-frequency percussive ventilation and low tidal volume ventilation in burns : A randomized controlled trial. In: Critical Care Medicine. 2010 ; Vol. 38, No. 10. pp. 1970-1977.
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TY - JOUR

T1 - High-frequency percussive ventilation and low tidal volume ventilation in burns

T2 - A randomized controlled trial

AU - Chung, Kevin K.

AU - Wolf, Steven

AU - Renz, Evan M.

AU - Allan, Patrick F.

AU - Aden, James K.

AU - Merrill, Gerald A.

AU - Shelhamer, Mehdi C.

AU - King, Booker T.

AU - White, Christopher E.

AU - Bell, David G.

AU - Schwacha, Martin G.

AU - Wanek, Sandra M.

AU - Wade, Charles E.

AU - Holcomb, John B.

AU - Blackbourne, Lorne H.

AU - Cancio, Leopoldo C.

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Objectives: In select burn intensive care units, high-frequency percussive ventilation is preferentially used to provide mechanical ventilation in support of patients with acute lung injury, acute respiratory distress syndrome, and inhalation injury. However, we found an absence of prospective studies comparing high-frequency percussive ventilation with contemporary low-tidal volume ventilation strategies. The purpose of this study was to prospectively compare the two ventilator modalities in a burn intensive care unit setting. Design: Single-center, prospective, randomized, controlled clinical trial, comparing high-frequency percussive ventilation with low-tidal volume ventilation in patients admitted to our burn intensive care unit with respiratory failure. Setting: A 16-bed burn intensive care unit at a tertiary military teaching hospital. Patients: Adult patients ≥18 yrs of age requiring prolonged (>24 hrs) mechanical ventilation were admitted to the burn intensive care unit. The study was conducted over a 3-yr period between April 2006 and May 2009. This trial was registered with ClinicalTrials.gov as NCT00351741. Interventions: Subjects were randomly assigned to receive mechanical ventilation through a high-frequency percussive ventilation-based strategy (n = 31) or a low-tidal volume ventilation-based strategy (n = 31). Measurements and main results: At baseline, both the high-frequency percussive ventilation group and the low-tidal volume ventilation group had similar demographics to include median age (interquartile range) (28 yrs [23-45] vs. 33 yrs [24-46], p = nonsignificant), percentage of total body surface area burn (34 [20-52] vs. 34 [23-50], p = nonsignificant), and clinical diagnosis of inhalation injury (39% vs. 35%, p = nonsignificant). The primary outcome was ventilator-free days in the first 28 days after randomization. Intent-to-treat analysis revealed no significant difference between the high-frequency percussive ventilation and the low-tidal volume ventilation groups in mean (± sd) ventilator-free days (12 ± 9 vs. 11 ± 9, p = nonsignificant). No significant difference was detected between groups for any of the secondary outcome measures to include mortality except the need for "rescue" mode application (p =.02). Nine (29%) in the low-tidal volume ventilation arm did not meet predetermined oxygenation or ventilation goals and required transition to a rescue mode. By contrast, two in the high-frequency percussive ventilation arm (6%) required rescue. Conclusions: A high-frequency percussive ventilation-based strategy resulted in similar clinical outcomes when compared with a low-tidal volume ventilation-based strategy in burn patients with respiratory failure. However, the low-tidal volume ventilation strategy failed to achieve ventilation and oxygenation goals in a higher percentage necessitating rescue ventilation.

AB - Objectives: In select burn intensive care units, high-frequency percussive ventilation is preferentially used to provide mechanical ventilation in support of patients with acute lung injury, acute respiratory distress syndrome, and inhalation injury. However, we found an absence of prospective studies comparing high-frequency percussive ventilation with contemporary low-tidal volume ventilation strategies. The purpose of this study was to prospectively compare the two ventilator modalities in a burn intensive care unit setting. Design: Single-center, prospective, randomized, controlled clinical trial, comparing high-frequency percussive ventilation with low-tidal volume ventilation in patients admitted to our burn intensive care unit with respiratory failure. Setting: A 16-bed burn intensive care unit at a tertiary military teaching hospital. Patients: Adult patients ≥18 yrs of age requiring prolonged (>24 hrs) mechanical ventilation were admitted to the burn intensive care unit. The study was conducted over a 3-yr period between April 2006 and May 2009. This trial was registered with ClinicalTrials.gov as NCT00351741. Interventions: Subjects were randomly assigned to receive mechanical ventilation through a high-frequency percussive ventilation-based strategy (n = 31) or a low-tidal volume ventilation-based strategy (n = 31). Measurements and main results: At baseline, both the high-frequency percussive ventilation group and the low-tidal volume ventilation group had similar demographics to include median age (interquartile range) (28 yrs [23-45] vs. 33 yrs [24-46], p = nonsignificant), percentage of total body surface area burn (34 [20-52] vs. 34 [23-50], p = nonsignificant), and clinical diagnosis of inhalation injury (39% vs. 35%, p = nonsignificant). The primary outcome was ventilator-free days in the first 28 days after randomization. Intent-to-treat analysis revealed no significant difference between the high-frequency percussive ventilation and the low-tidal volume ventilation groups in mean (± sd) ventilator-free days (12 ± 9 vs. 11 ± 9, p = nonsignificant). No significant difference was detected between groups for any of the secondary outcome measures to include mortality except the need for "rescue" mode application (p =.02). Nine (29%) in the low-tidal volume ventilation arm did not meet predetermined oxygenation or ventilation goals and required transition to a rescue mode. By contrast, two in the high-frequency percussive ventilation arm (6%) required rescue. Conclusions: A high-frequency percussive ventilation-based strategy resulted in similar clinical outcomes when compared with a low-tidal volume ventilation-based strategy in burn patients with respiratory failure. However, the low-tidal volume ventilation strategy failed to achieve ventilation and oxygenation goals in a higher percentage necessitating rescue ventilation.

KW - burns

KW - high frequency

KW - inhalation injury

KW - lowtidal volume ventilation

KW - percussive ventilation

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