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Dr. Brian Cuthbertson, anesthesiologist and intensivist and lead author of the OSCAR trial, shares with us the fascinating history of high frequency oscillatory ventilation.
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I am a frequent listener to your podcast and really appreciate the content you produce. I am a ICU nurse. What was said in this conversation about being a believer in therapies really resonates with me. I frequently run into this issue and actively try to combat it. There are only patients and tools. And the tool is either the right or the wrong tool for the job. Use a hammer to pound a nail but don’t try to remove a lug nut with it. If you believe in the hammer, you might be sitting at the side of the road changing your tire for an awful long time. This episode also brings up a question I have about the related but mechanist distinct method of mechanical ventilation used by the VDR-4. It is similar in that it uses high frequency sub-tidal breaths at a frequency of 400-700 Hz but does so in an open circuit rather than a closed circuit. It is my understanding that this mode of ventilation has strong supporting evidence in the burns/inhalation injury literature but I have also seen it used in asthma, COPD, ARDS and other forms of respiratory failure. I was curious if your guest had any expertise in this area and could provide insight.
Agree with all that!
Percussive ventilation has had a pretty niche utilization, particularly in domains like burn care. I haven’t had any personal experience with it; let me see if Brian can weigh in.
I’m afraid I don’t have expertise on this, but it is broadly similar to HFOV with some key differences. It is probably too strong a statement to say that there is “strong supportive evidence in burns/ inhalation injury”. The evidence base for this supportive treatment is at the same state that it was for HFOV when we started the OSCAR and Oscillate trials. If you believe in the mechanical power argument, then this could well be harmful like HFOV. I would suggest that high-quality randomised controlled trials would need done before further use of this treatment since our priors would be that there is a significant risk of harm. Thanks for the question.