{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:20:25Z","timestamp":1789554025070,"version":"build-2803163510"},"reference-count":125,"publisher":"National Institute for Health and Care Research","issue":"23","license":[{"start":{"date-parts":[[2015,3,1]],"date-time":"2015-03-01T00:00:00Z","timestamp":1425168000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["06\/04\/01"],"award-info":[{"award-number":["06\/04\/01"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title><jats:p>Patients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-2\"><jats:title>Objectives<\/jats:title><jats:p>To determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-3\"><jats:title>Design<\/jats:title><jats:p>A parallel, randomised, unblinded clinical trial.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-4\"><jats:title>Setting<\/jats:title><jats:p>UK intensive care units.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-5\"><jats:title>Participants<\/jats:title><jats:p>Mechanically ventilated patients with a partial pressure of oxygen in arterial blood\/fractional concentration of inspired oxygen (P\u2009:\u2009F) ratio of 26.7\u2009kPa (200\u2009mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-6\"><jats:title>Interventions<\/jats:title><jats:p><jats:italic>Treatment arm<\/jats:italic>\u2002HFOV using a Novalung R100<jats:sup>\u00ae<\/jats:sup>ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning.<jats:italic>Control arm<\/jats:italic>\u2002Conventional mechanical ventilation using the devices available in the participating centres.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-7\"><jats:title>Main outcome measures<\/jats:title><jats:p>The primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-8\"><jats:title>Results<\/jats:title><jats:p>One hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (<jats:italic>p<\/jats:italic>\u2009=\u20090.85), for an absolute difference of 0.6% [95% confidence interval (CI) \u22126.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P\u2009:\u2009F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40;<jats:italic>p<\/jats:italic>\u2009=\u20090.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to society per QALY of \u00a388,790 and an ICER for the cost to the NHS per QALY of \u00a378,260.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-9\"><jats:title>Conclusions<\/jats:title><jats:p>The use of HFOV had no effect on 30-day mortality in adult patients undergoing mechanical ventilation for ARDS and no economic advantage. We suggest that further research into avoiding ventilator-induced lung injury should concentrate on ventilatory strategies other than HFOV.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-10\"><jats:title>Trial registration<\/jats:title><jats:p>Current Controlled Trials ISRCTN10416500.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-11\"><jats:title>Funding<\/jats:title><jats:p>This project was funded by the NIHR Health Technology Assessment programme and will be published in full in<jats:italic>Health Technology Assessment<\/jats:italic>; Vol. 19, No. 23. See the NIHR Journals Library website for further project information.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta19230","type":"journal-article","created":{"date-parts":[[2015,3,26]],"date-time":"2015-03-26T13:55:50Z","timestamp":1427378150000},"page":"1-178","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study"],"prefix":"10.3310","volume":"19","clinical-trial-number":[{"clinical-trial-number":"isrctn10416500","registry":"10.18810\/isrctn","type":"results"}],"author":[{"given":"Ranjit","family":"Lall","sequence":"first","affiliation":[{"name":"Warwick Clinical Trials Unit, University of Warwick, Warwick, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Hamilton","sequence":"additional","affiliation":[{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"Young","sequence":"additional","affiliation":[{"name":"John Radcliffe Hospital, Oxford, UK"},{"name":"University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Hulme","sequence":"additional","affiliation":[{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hall","sequence":"additional","affiliation":[{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjoy","family":"Shah","sequence":"additional","affiliation":[{"name":"Bristol Royal Infirmary, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"MacKenzie","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Tunnicliffe","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Rowan","sequence":"additional","affiliation":[{"name":"Intensive Care National Audit & Research Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Cuthbertson","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"McCabe","sequence":"additional","affiliation":[{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sallie","family":"Lamb","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, University of Warwick, Warwick, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the OSCAR collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2015,3]]},"reference":[{"key":"key20150324093948399_ref1-bib1","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1378\/chest.121.6.1972","article-title":"Incidence of ARDS in an adult population of northeast Ohio","volume":"121","author":"Arroliga","year":"2002","journal-title":"Chest"},{"key":"key20150324093948399_ref1-bib2","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1164\/ajrccm.165.4.2101124","article-title":"Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states","volume":"165","author":"Bersten","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"key20150324093948399_ref1-bib3","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s00134-003-2136-x","article-title":"Epidemiology and outcome of acute lung injury in European intensive care units. 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