HFOV vs APRV for ARDS

[DarkProtonics]

What are the advantages and disadvantages of HFOV vs APRV for ARDS? Would combining either one of them w/ partial liquid ventilation and using heliox result in improvement in gas exchange?

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[RT2MD]

Niether HFOV or APRV have many good studies that investigate their use in ARDS. The only real study that had been done is the ARDSnet studies. They advocate a low Vt, high rate ventilatory strategy in conjunction with higher PEEP levels. Permissive hypercapnia, and lower PaO2s are also considered acceptable.

This being said, I have utilized both of those modes of ventilation for severe ARDS with success. The main idea with these modes is to eliminate trauma from opening and closing of alveoli.

PLV has been studied before, but I don't know what happened with those studies. I know that the PLV trials in the Kansas City area were halted early. I believe that they were being used in the neonatal population.

Heliox doesn't help with gas exchange. The advantage of heliox is that it can be used in severe obstructive disease (or a foreign object) to deliver oxygen to the lungs. You can't use it to deliver more than 30% oxygen, either, because the gas gets too heavy.

A lot typed, with no real answers to your questions! Sorry.

 

[JayneCobb]

What are the advantages and disadvantages of HFOV vs APRV for ARDS?

As already pointed out, there are no known advantages, currently. HFOV is currently being studied as is APRV so it will probably be a bit before these are done. Interestingly, it seems only APRV is being compared to current practices but has a very low enrollment number.