High-frequency percussive ventilation in cardiac surgery patients failing mechanical conventional ventilation†
Interactive Cardiovascular and Thoracic Surgery
OBJECTIVES: Failure of mechanical conventional ventilation (MCV) after cardiac surgery portends a dismal prognosis, with extracorporeal membrane oxygenation frequently utilized as a salvage therapy. We describe our experience with high-frequency percussive ventilation (HFPV) as a rescue therapy for hypoxaemia refractory to MCV after cardiac surgery. METHODS: In a 6-year retrospective analysis from 2009 to 2015, we identified 16 subjects who required HFPV after cardiac surgery. Data regarding
... . Data regarding demographics, intraoperative details, postoperative ventilatory settings including length of time on HFPV and postoperative outcomes were collected. The primary outcome was improvement in oxygenation as measured by pre-and post-HFPV partial pressures of oxygen (pO 2 ) and ratio of pO 2 to fraction of inspired oxygen (P/F ratio). RESULTS: Sixteen patients required HFPV after cardiac surgery. Operative procedures included coronary artery bypass surgery (n = 6), aortic aneurysm or dissection repair (n = 5), valve with bypass surgery (n = 2), aortic valve replacement (n = 2) and extracorporeal membrane oxygenation (n = 1). Median pO 2 increased from 61 to 149.5 mmHg (P < 0.001) and the median P/F ratio improved from 62 to 169 (P < 0.001). The improvement in pO 2 and P/F ratio was durable at 24 h whether the patient was returned to MCV (n = 4) or remained on HFPV (n = 12) with pO 2 and P/F ratio increasing from 61 to 104 mmHg (P < 0.001) and from 62 to 193.5 (P < 0.001), respectively. Survival to discharge was 81%. CONCLUSIONS: In our cohort of cardiac surgical patients, HFPV was successfully utilized as a rescue therapy, obviating the need for extracorporeal membrane oxygenation. Although further studies are warranted, HFPV should be considered in cardiac surgical patients failing MCV.