Godet et al. Critical Care (2018) 22:3
High frequency percussive ventilation
increases alveolar recruitment in early
acute respiratory distress syndrome: an
experimental, physiological and CT scan
Thomas Godet¹2, Matthieu Jabaudon¹2, Raïko Blondonnet¹,2, Aymeric Tremblay³, Jules Audard ¹2, Benjamin Rieu¹,
Bruno Pereira, Jean-Marc Garcier, Emmanuel Futier¹,2 and Jean-Michel Constantin ¹.2*
Background: High frequency percussive ventilation (HFPV) combines diffusive (high frequency mini-bursts) and
convective ventilation patterns. Benefits include enhanced oxygenation and hemodynamics, and alveolar recruitment,
while providing hypothetic lung-protective ventilation. No study has investigated HFPV-induced changes in lung
aeration in patients with early acute respiratory distress syndrome (ARDS).
* Correspondence: firstname.lastname@example.org
¹Departement de Médecine Périopératoire (MPO), Hôpital Estaing, Centre
Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 place Lucie Aubrac,
Clermont-Ferrand F-63003, France
²Université Clermont Auvergne, Laboratoire Universitaire GRED, UMR/CNRS
6293, INSERM U1103, Clermont-Ferrand F-63003, France
Full list of author information is available at the end the article
Methods: Eight patients with early non-focal ARDS were enrolled and five swine with early non-focal ARDS were
studied in prospective computed tomography (CT) scan and animal studies, in a university-hospital tertiary ICU and an
animal laboratory. Patients were optimized under conventional "open-lung" ventilation. Lung CT was performed using
an end-expiratory hold (Conv) to assess lung morphology. HFPV was applied for 1 hour to all patients before new CT
scans were performed with end-expiratory (HFPV EE) and end-inspiratory (HFPV EI) holds. Lung volumes were
determined after software analysis. At specified time points, blood gases and hemodynamic data were collected.
Recruitment was defined as a change in non-aerated lung volumes between Conv, HFPV EE and HFPV El. The
main objective was to verify whether HFPV increases alveolar recruitment without lung hyperinflation. Correlation
between pleural, upper airways and HFPV-derived pressures was assessed in an ARDS swine-based model.
Results: One-hour HFPV significantly improved oxygenation and hemodynamics. Lung recruitment significantly
rose by 12.0% (8.5-18.0%), P = 0.05 (Conv-HFPV EE) and 12.5% (9.3–16.8%), P=0.003 (Conv-HFPV EI). Hyperinflation
tended to increase by 2.0% (0.5-2.5%), P=0.89 (Conv-HFPV EE) and 3.0% (2.5-4.0%), P = 0.27 (Conv-HFPV EI). HFPV
hyperinflation correlated with hyperinflated and normally-aerated lung volumes at baseline: r=0.79, P = 0.05 and
r=0.79, P=0.05, respectively (Conv-HFPV EE); and only hyperinflated lung volumes at baseline: r=0.88, P=0.01
(Conv-HFPV EI). HFPV CT-determined tidal volumes reached 5.7 (1.1-8.1) mL.kg¹ of ideal body weight (IBW).
Correlations between pleural and HFPV-monitored pressures were acceptable and end-inspiratory pleural pressures
remained below 25cmH₂0.
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