High-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case Series.

Journal: The American Journal Of Case Reports
Treatment Used: High-Frequency Oscillatory Ventilation (HFOV)
Number of Patients: 3
Published:
MediFind Summary

Summary: This article reviewed three cases of patients with refractory (resistant to treatment) hypoxemia (abnormally low level of oxygen in the blood) in severe COVID-19 pneumonia (lung infection that causes inflammation in the tiny air sacs inside the lungs due to a pandemic infection caused by a coronavirus) who utilized high-frequency oscillatory ventilation (type of mechanical ventilation which utilizes a respiratory rate greater than four times the normal value; HFOV).

Conclusion: All 3 patients were ultimately liberated from mechanical ventilation (machine that takes over the work of breathing when a person is not able to breathe enough on their own) and discharged from the hospital to return to functional independence. High-frequency oscillatory ventilation (type of mechanical ventilation which utilizes a respiratory rate greater than four times the normal value) offered advantages in the management of certain critically ill patients with severe COVID-19 pneumonia (lung infection that causes inflammation in the tiny air sacs inside the lungs due to a pandemic infection caused by a coronavirus) and might be considered in cases refractory (resistant to treatment) to standard management strategies.

Abstract

BACKGROUND COVID-19 continues to place a tremendous burden on the healthcare system, with most deaths resulting from respiratory failure. Management strategies have varied, but the mortality rate for mechanically ventilated patients remains high. Conventional management with ARDSnet ventilation can improve outcomes but alternative and adjunct treatments continue to be explored. High-frequency oscillatory ventilation (HFOV), a modality now rarely used in adult critical care medicine, may offer an alternative treatment option by maximizing lung protection and limiting oxygen toxicity in critically ill patients failing conventional ventilator strategies. CASE REPORT We present 3 patients with severe acute respiratory distress syndrome (ARDS) and sepsis due to COVID-19 who all improved clinically after transitioning from conventional ventilation to HFOV. Two patients developed refractory hypoxemia with hemodynamic instability and multiple organ failure requiring vasopressor support and renal replacement therapy. After failing to improve with all available therapies, both patients stabilized and ultimately improved after being placed on HFOV. The third patient developed severe volutrauma/barotrauma despite extreme lung protection and ARDSnet ventilation. He showed improvement in oxygenation and signs of lung trauma slowly improved after initiating HFOV. All 3 patients were ultimately liberated from mechanical ventilation and discharged from the hospital to return to functional independence. CONCLUSIONS Our experience suggests that HFOV offers advantages in the management of certain critically ill patients with ARDS due to COVID-19 pneumonia and might be considered in cases refractory to standard management strategies.

Authors
Philip Keith, L Scott, Linda Perkins, Rebecca Burnside, Matthew Day

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