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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

  • Federico Angriman
  • Bruno L. Ferreyro
  • Lachlan Donaldson
  • Brian H. Cuthbertson
  • Niall D. Ferguson
  • Casper W. Bollen
  • Thomas E. Bachman
  • François Lamontagne
  • Neill K. J. AdhikariEmail author
Letter

Dear Editor,

The acute respiratory distress syndrome (ARDS) may encompass sub-populations that respond differently to treatments [1]. 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 [2]. 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) [3] 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 [4].

The main exposure was HFOV, and the primary...

Notes

Author contributions

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.

Funding

Dr. Angriman is partially supported by research funding from the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre.

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

134_2019_5806_MOESM1_ESM.pdf (405 kb)
Supplementary material 1 (pdf 406 kb)

References

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    Calfee CS, Delucchi K, Parsons PE et al (2014) Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. Lancet Respir Med 2:611–620.  https://doi.org/10.1016/S2213-2600(14)70097-9 CrossRefPubMedPubMedCentralGoogle Scholar
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    Sklar MC, Fan E, Goligher EC (2017) High-frequency oscillatory ventilation in adults with ARDS. Chest 152:1306–1317.  https://doi.org/10.1016/j.chest.2017.06.025 CrossRefPubMedGoogle Scholar
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    Meade MO, Young D, Hanna S et al (2017) Severity of hypoxemia and effect of high-frequency oscillatory ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 196:727–733.  https://doi.org/10.1164/rccm.201609-1938OC CrossRefPubMedGoogle Scholar
  4. 4.
    Ferguson ND, Cook DJ, Guyatt GH et al (2013) High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 368:795–805.  https://doi.org/10.1056/NEJMoa1215554 CrossRefPubMedGoogle Scholar
  5. 5.
    Mekontso Dessap A, Boissier F, Charron C et al (2016) Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive Care Med 42:862–870.  https://doi.org/10.1007/s00134-015-4141-2 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Federico Angriman
    • 1
    • 2
    • 3
  • Bruno L. Ferreyro
    • 2
    • 3
    • 4
  • Lachlan Donaldson
    • 1
    • 2
  • Brian H. Cuthbertson
    • 1
    • 2
    • 3
  • Niall D. Ferguson
    • 2
    • 3
    • 4
    • 5
  • Casper W. Bollen
    • 6
  • Thomas E. Bachman
    • 7
  • François Lamontagne
    • 8
  • Neill K. J. Adhikari
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Critical Care MedicineSunnybrook Health Sciences CentreTorontoCanada
  2. 2.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  3. 3.Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  4. 4.Department of Medicine, Sinai Health System and University Health NetworkTorontoCanada
  5. 5.Research InstituteToronto General HospitalTorontoCanada
  6. 6.Pediatric Intensive Care UnitUniversity Medical Center UtrechtUtrechtThe Netherlands
  7. 7.Department of Biomedical Technology, School of Biomedical EngineeringCzech Technical University in PraguePragueCzech Republic
  8. 8.Department of MedicineUniversité de SherbrookeSherbrookeCanada

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