Effect of Continuous High-Frequency Oscillation Therapy on Lung Aeration in Mechanically Ventilated Patients With Impaired Consciousness

BACKGROUND: Atelectasis frequently occurs in patients with impaired consciousness who are being treated with invasive mechanical ventilation. It is mainly caused by secretion accumulation, which can lead to longer durations of ventilation and ICU stay. RESEARCH QUESTION: Does continuous high-frequency oscillation (CHFO) therapy improve lung aeration and reduce atelectasis in adults with impaired consciousness who are mechanically ventilated? STUDY DESIGN AND METHODS: This multicenter, single-anonymized, randomized controlled trial was conducted across 11 hospitals in China. Adult patients with impaired consciousness (Glasgow Coma Scale score ≤ 8) who required invasive mechanical ventilation were randomly assigned in a 1:1 ratio to either the CHFO or usual care group. The CHFO group received 3 to 4 sessions daily. The primary outcome was the percent change in nonaerated lung tissue, measured by CT scan, from baseline to day 5, as analyzed in the intention-to-treat population. RESULTS: From June 19, 2023, to July 2, 2024, a total of 80 patients were included in the intention-to-treat analysis. Five patients from each group were excluded from the primary analysis due to incomplete CT scans. On day 5, the decrease in nonaerated lung tissue was greater in the CHFO group (-51.3%; 95% CI, -62.7 to -40.0) compared with the usual care group (-37.6%; 95% CI, -49.3 to -26.0), with a mean difference of -13.69% (95% CI, -24.86 to -2.52; P = .017). The CHFO group also had a higher number of ventilator-free days, a lower clinical pulmonary infection score, and a shorter ICU stay. No adverse events of interest were observed during the study. INTERPRETATION: In patients with impaired consciousness who are mechanically ventilated, 5 days of CHFO treatment was shown to significantly reduce nonaerated lung tissue. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry; No.: ChiCTR2300070988; https://www.chictr.org.cn.