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2012, Number 2

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Med Sur 2012; 19 (2)

High-frequency oscillatory ventilation in patients with pneumonia secondary to influenza A H1N1 and hypoxemia refractory to conventional mechanical ventilation

Carrillo-Esper R, Arch-Tirado E, Garnica-Escamilla MA

Language: Spanish
References: 26
Page: 68-75
PDF size: 134.11 Kb.


ABSTRACT

Introduction. Pneumonia secondary to A H1N1 can lead to primary ARDS and hypoxemia refractory to conventional ventilation. In these cases the high frequency oscillatory ventilation (HFOV) can be a good therapeutic alternative. Objective. To describe the evolution and response of patients with influenza A H1N1- induced pneumonia and hypoxemia refractory to conventional ventilation treated with HFOV. Material and methods. Two patients with severe pneumonia with hypoxemia refractory to conventional ventilation, which was defined as PaO2 levels < 80 mmHg with FiO > 80% during pressure-controlled ventilation with a protective and maximal recruitment strategy, with positive end-expiratory pressure (PEEP) of > 20 cmH2O, tidal volume (TV) between 6 to 8 mL/kg and respiratory frequency between 15 to 18/min. The HFOV was programmed initially with 5 Hertz (Hz), mean airway pressure (MAP) of 25 mmHg and inspired oxygen fraction of 100%, which decreased in accordance to the evolution until the 40% was reached. Respiratory and hemodynamic parameters were evaluated before and after the HFOV, these parameters were: PaO2, SaO2, Kirby index (KI), arterial pressure of carbon dioxide (PACO2), shunts (Qs, Qt). The hemodynamic parameters were: central venous oxygen saturation ScvO2, cardiac output (CO), cardiac index (CI) and systolic volume variation (SVV). Results. The HFOV significantly increased the PaO2 from 80 to 100 mmHg (p = 0.011), the KI, the ScvO2 and was associated with the decrease of intrapulmonary shunt. During the ventilatory procedure hemodynamic deterioration was not present, which was evident due to the SVV normalization and the upkeep of the CO and CI, both patients survived. Conclusion. The HFOV is a good ventilatory alternative for patients with severe pneumonia secondary to the virus of A H1N1 influenza with hypoxemia refractory to conventional ventilation.


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