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OSCAR

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High-Frequency Oscillation for ARDS

  • Included 795 patients within 7 days of undergoing mechanical ventilation with ARDS (Fi02:Pa02 < 200 and bilateral pulmonary infiltrates) and an expectation of at least 2 more days of mechanical ventilation
  • Randomized patients to high- frequency oscillation ventilation (HFOV – Novalung R100) or conventional low tidal volume mechanical ventilation
  • Primary endpoint (30-day mortality) was not different between HOV and conventional groups (41.7% vs. 41.1%, 95% CI -6.1 to 7.5)
  • There was no difference between HFOV and conventional patients in ventilator-free days (17.6 vs. 17_1, P=0-42), ICU length of stay (17.6 vs: 16.1 days, p=0.18), or hospital stay (33.9 vs. 33.1 days, p=0.79)
  • Neuromuscular-blocking drugs were used for a longer duration with HFOV (2.5 vs. 2 days, p=0.02), likely due to the fact that the HFOV mode has no facility to allow for spontaneous patient breaths
  • There was no difference in days with inotropic or vasopressor agents between HFOV and conventional ventilation (2.9 vs. 2.8 days, p=0.74)
  • It is unclear why a difference in mortality was not seen (as it was with the OSCILLATE trial).
  • OSCILLATE used a different HFOV ventilator, mandated (not suggested) lunq protection strategies, and had a significantly lower control group mortality rate

TBL


High-frequency oscillation ventilation in patients with ARDS did not improve mortality or length of stay compared to conventional, low tidal volume mechanical ventilation.


See the paper here



 

OSCILLATEImage result for oscillate

High-frequency oscillation for ARDS

  • Included 548 patients within 14 days of pulmonary symptoms, were undergoing mechanical ventilation with ARDS (Fi02:Pa02 < 200 and bilateral pulmonary infiltrates), and had an expectation of at least 2 more days of mechanical ventilation.
  • Patients needed to be enrolled within 72 hours of meeting criteria.
  • Randomized patients to high- frequency oscillation ventilation (HFOV – SensorMedics 3100B) or conventional low tidal volume mechanical ventilation.
  • Both groups; had specific, protocolized titration and weaning procedures.
  • Primary endpoint (in-hospital mortality) was higher with HFOV (47% vs. 35%, NNH 9, p=0-005)
  • HFOV patients were more likely to require vasopressor therapy (91% vs. 84%, p=0.01) and neuromuscular blockers (83% vs. 68%, p<0.001).
  • This effect was seen as early as 4 hours after the initiation of HFOV.
  • Conventional ventilation was associated with more refractory hypoxemia (7% vs. 14%, p=0.007), but this did not translate to a greater mortality rate due to hypoxemia (79% vs. 66%, p=0.31)
  • Of note, the steering committee terminated the study early despite the fact that the threshold P value had not been reached. Stopping early tends to overestimate the magnitude of effect (harm or benefit)
  • It is unclear why a difference in mortality was seen (given that the OSCAR trial showed no difference in mortality).
  • OSCILLATE used a different HFOV ventilator, mandated (not suggested) lung protection strategies, and had a significantly lower control group mortality rate-
  • Finally, because OSCILLATE was stopped early, the magnitude of harm may be overestimated.

TBL


High-frequency oscillation ventilation in patients with early ARDS increased mortality compared to conventional, low tidal volume mechanical ventilation.


See the paper here



 

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