The recently reported differences between pulmonary and extrapulmonary acute respiratory distress syndromes (ARDSp, ARDSexp) are the main reasons of scientific discussion on potential differences in the effects of current ventilatory strategies. The aim of this study is to assess whether the presence of ARDSp or ARDSexp can differently affect the beneficial effects of high-frequency oscillatory ventilation (HFOV) upon physiological and clinical parameters. Thirty adults fulfilling the ARDS criteria were indicated for HFOV in case of failure of conventional
ventilation strategy. According to the ARDS type, each patient was included either in the group of patients with ARDSpor ARDSexp. Six hours after normocapnic HFOV introduction, there was no significant increase in PaO
2/FIO2 in ARDSpgroup (from 129±47 to 133±50 Torr), but a significant improvement was found in ARDSexp (from 114±54 to 200±65 Torr, p<0.01). Despite the insignificant difference in the latest mean airway pressure (MAP) on conventional mechanical ventilation (CMV) between both groups, initial optimal continuous distension pressure (CDP) for the best
PaO2/FIO2 during HFOV was 2.0±0.6 kPa in ARDSp and 2.8±0.6 kPa in ARDS
exp (p<0.01). HFOV recruits and thus it is more effective in ARDSexp. ARDS
exp patients require higher CDP levels than ARDSp patients. The testing period for positive effect of HFOV is recommended not to be longer than 24 hours.
Although the fluid therapy plays a fundamental role in the
management of polytrauma patients (PP), a tool which could
determine it appropriately is still lacking. The aim of this study
was to evaluate the application of a bioimpedance spectroscopy
(BIS) for body fluids volume and distribution monitoring in these
patients. This prospective, observational study was performed on
25 severe PP and 25 healthy subjects. The body fluids
composition was repeatedly assessed using BIS between days 3
to 11 of intensive care unit stay while the impact of fluid intake
and balance was evaluated. Fluid intake correlated significantly
with fluid excess (FE) in edemas, and their values were
significantly higher in comparison with the control group. FE was
strongly associated with cumulative fluid balance (p<0.0001,
r=0.719). Furthermore, this parameter was associated with the
entire duration of mechanical ventilation (p=0.001, r=0.791)
independently of injury severity score. In conclusion, BIS
measured FE could be useful in PP who already achieved
negative fluid balance in prevention the risk of repeated
hypovolemia through inappropriate fluid restriction. What is
more, measured FE has a certain prognostic value. Further
studies are required to confirm BIS as a potential instrument for
the improvement of PP outcome.