The harm of high-frequency oscillatory ventilation (HFOV) in ARDS is not related to a high baseline risk of acute cor pulmonale or short-term changes in hemodynamics
The acute respiratory distress syndrome (ARDS) may encompass sub-populations that respond differently to treatments . High-frequency oscillatory ventilation (HFOV) related harm may be due to ventilator-induced lung injury (VILI) or hemodynamic instability explained by right ventricle (RV) failure that is present at baseline or that develops after HFOV is started . Our objective was to evaluate whether the baseline risk of RV failure modified the effect of HFOV on mortality among ARDS patients and whether the effect of HFOV was mediated by short-term changes in hemodynamics.
We performed a secondary analysis of an individual patient data meta-analysis (IPDMA)  of four trials of HFOV vs. conventional ventilation in adults with ARDS. Because of limited availability of data regarding physiologic changes after randomization, the causal mediation analysis of hemodynamic change included data only from the OSCILLATE trial .
The main exposure was HFOV, and the primary...
FA, BLF, and NKJA conceived of the study. BHC, NDF, CWB, and TEB contributed data from the original trials of HFOV. FA analysed the data. FA, BLF, and NKJA drafted the manuscript. All authors interpreted data, revised the manuscript, and approved the final version. NKJA supervised the study.
Dr. Angriman is partially supported by research funding from the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre.
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Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.