Use of high-frequency oscillatory ventilation in burn patients.

BACKGROUND Patients with major burn injuries frequently develop acute respiratory distress syndrome (ARDS). High-frequency oscillatory ventilation (HFOV) has been used successfully in our regional burn center since 1999 for the management of oxygenation failure secondary to ARDS and as a method of intraoperative ventilation to allow surgical burn wound excision to proceed, despite the presence of severe ARDS. OBJECTIVE The objective of this article is to review the use of HFOV in burn patients, with an emphasis on the indications and selection criteria for the initiation of HFOV, special considerations for patients with smoke inhalation injury, and our approach to intra-operative HFOV. SETTING Adult regional burn center in a university-affiliated tertiary care hospital. RESULTS We have now used HFOV in 36 severely burned patients, 33% of whom had an associated smoke inhalation injury. HFOV produced significant improvements in oxygenation among burn patients with oxygenation failure secondary to ARDS. HFOV produced a slower and less robust reversal of oxygenation failure in those with smoke inhalation compared with patients with burns alone. HFOV has been used intraoperatively for 33 procedures in 18 patients without complications. CONCLUSION HFOV has been an indispensable ventilation modality in our burn center, and has played an important role in reversing oxygenation failure in patients with ARDS and in facilitating early excision and closure of the burn wound in these patients.