Biarent D
Pediatric and Neonatal Intensive Care Unit, Hôpital Universitaire des Enfants, Reine Fabiola, Brussels, Belgium.
Pediatr Pulmonol Suppl. 1999;18:178-81.
Protection of the lungs against ventilator-induced lung injury is becoming one of the main concerns in pediatric and neonatal intensive care. High frequency ventilation using a constant distending pressure with small variations during respiratory cycles allows adequate recruitment. High frequency oscillation is the most promising HFV mode especially in premature neonates but clinical studies are contradictory. Nitric oxide, an inhaled gas with specific pulmonary vasodilating effects, has become a powerful tool in the treatment of pulmonary arterial hypertension alone or in combination with HFO, but studies have failed to show improvement in survival in neonates as well as in children with ARDS. Tracheal gas insufflation, in addition to conventional ventilation, by washing dead space during exhalation, improves gas exchange while lowering tidal volume. It is however still experimental. Maintenance of spontaneous ventilation during conventional ventilation improves gas exchange, hemodynamic functions, mobilization, active coughing, and avoids prolonged muscle weakness. Non invasive modes of ventilation like BiPAP have certain indications in pediatrics but need to become more familiar to the pediatric intensivist.
保护肺部免受呼吸机诱导的肺损伤正成为儿科和新生儿重症监护中的主要关注点之一。高频通气在呼吸周期中使用恒定的扩张压力且变化较小，可实现充分的肺复张。高频振荡是最有前景的高频通气模式，尤其是在早产儿中，但临床研究结果相互矛盾。一氧化氮是一种具有特定肺血管舒张作用的吸入气体，已成为单独或与高频振荡通气联合治疗肺动脉高压的有力工具，但研究未能显示其能改善新生儿以及急性呼吸窘迫综合征患儿的生存率。除传统通气外，气管内气体注入通过在呼气时冲洗死腔来改善气体交换，同时降低潮气量。然而，它仍处于实验阶段。在传统通气期间维持自主通气可改善气体交换、血流动力学功能、活动能力、主动咳嗽，并避免长期肌肉无力。像双水平气道正压通气（BiPAP）这样的无创通气模式在儿科有一定的适应证，但需要儿科重症监护医生更加熟悉。
