Andersen F A, Guttormsen A B, Flaatten H K
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Acta Anaesthesiol Scand. 2002 Oct;46(9):1082-8. doi: 10.1034/j.1399-6576.2002.460905.x.
At present there are limited data about the effects of high frequency oscillatory ventilation (HFOV) in adult patients with acute respiratory distress syndrome (ARDS). This study evaluates efficacy of HFOV in such patients.
Sixteen ARDS patients, mean age 38.2 years (range 18-76), that underwent HFOV between 1997 and 2001 were enrolled in the study and evaluated in retrospect. FIo2, arterial blood gases, mean airway pressure (mean Paw), blood pressure, heart rate and central venous pressure were recorded by 4, 8, 12, 24, 48 and 72 h of HFOV and compared to conventional mechanical ventilation (CMV) at baseline (4 h prior to HFOV).
On admission to the ICU, mean Simplified Acute Physiology score (SAPS II) was 40.3 (SD 12.6). Main causes of ARDS were pneumonia (9/16) and burn injuries (4/16). At baseline the patients had severe ARDS as noted by a mean lung injury score (LIS) of 3.2 (SD 0.3) and Pao2/FIo2 ratio 12.2 (SD 3.2) kPa. Within 4 h of HFOV, Pao2/FIo2 increased to 17.3 (SD 5.9) kPa (P = 0.016). Throughout HFOV, Pao2/FIo2 was significantly higher than at baseline. There were no significant changes in haemodynamic parameters. Ending HFOV after 6.6 (SD 3.2) days, survivors (n = 11) significantly reduced their Sequential Organ Failure Assessment Score (SOFA) compared to baseline. Survival at 3 months was 68.8%.
HFOV effectively improves oxygenation without haemodynamic compromise. During HFOV, the SOFA score may predict outcome.
目前，关于高频振荡通气（HFOV）对成人急性呼吸窘迫综合征（ARDS）患者的影响的数据有限。本研究评估了HFOV对此类患者的疗效。
选取1997年至2001年间接受HFOV治疗的16例ARDS患者，平均年龄38.2岁（范围18 - 76岁），进行回顾性评估。在HFOV治疗的4、8、12、24、48和72小时记录FiO₂、动脉血气、平均气道压（平均Paw）、血压、心率和中心静脉压，并与基线（HFOV前4小时）时的传统机械通气（CMV）进行比较。
入住重症监护病房（ICU）时，简化急性生理学评分（SAPS II）平均为40.3（标准差12.6）。ARDS的主要病因是肺炎（9/16）和烧伤（4/16）。基线时，患者患有严重ARDS，平均肺损伤评分（LIS）为3.2（标准差0.3），动脉血氧分压/吸入氧分数值（Pao₂/FiO₂）为12.2（标准差3.2）kPa。在HFOV治疗4小时内，Pao₂/FiO₂升至17.3（标准差5.9）kPa（P = 0.016）。在整个HFOV治疗期间，Pao₂/FiO₂显著高于基线水平。血流动力学参数无显著变化。在6.6（标准差3.2）天后结束HFOV治疗，存活者（n = 11）的序贯器官衰竭评估评分（SOFA）较基线显著降低。3个月时的生存率为68.8%。
HFOV可有效改善氧合，且不影响血流动力学。在HFOV治疗期间，SOFA评分可预测预后。
