Alveolar recruitment of atelectasis under combined high-frequency jet ventilation: a computed tomography study.

Abstract

To quantify the effect of superimposed high-frequency jet ventilation on lung recruitment in adult patients with acute lung injury. Prospective clinical study in the intensive care unit of a university teaching hospital. Eight adults suffering from acute lung injury with a mean lung injury score of 2.6+/-0.6 and pronounced atelectasis in at least two lung quadrants. The cause was either pneumonia ( n=5) or postoperative sepsis ( n=3). Superimposed high-frequency jet ventilation was initiated in patients following a mean of 4.4+/-1.7 days of conventional ventilation. Before and 4 h after the start of superimposed high-frequency jet ventilation differential lung volumes were determined by volumetry using computed tomography. Superimposed high-frequency jet ventilation significantly increased the lung volume of every patient due to alveolar recruitment. This was achieved despite lower peak inspiratory pressures and higher PaO(2)/FIO(2) ratios than with conventional ventilation. Treatment with superimposed high-frequency jet ventilation for 4 h resulted in rapid alveolar recruitment in dependent lung areas, improved gas exchange, and better arterial oxygenation. It offers an effective and advantageous alternative to conventional ventilation for ventilatory management of respiratory insufficient patients.