Paulsen Stephen M, Killyon Garry W, Barillo David J
Adult Burn Center, Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
Am Surg. 2002 Oct;68(10):852-6; discussion 856.
Despite multiple advances in critical care patients with severe adult respiratory distress syndrome (ARDS) can exhaust the capability of conventional ventilation; this results in respiratory failure and death. High-frequency percussive ventilation (HFPV), which was initially utilized for salvage of burn patients with smoke inhalation injury refractory to conventional ventilation, has evolved as a standard of burn care. Based on our experience with HFPV in burn patients the burn team was consulted to provide salvage ventilation for non-burn surgical intensive care unit patients with refractory respiratory failure. Over a 14-month period ten patients with refractory ARDS from multiple causes were treated. Retrospective chart review was performed. Respiratory parameters were assessed before and 24 hours after initiation of HFPV. Mean values of fraction of inspired oxygen (FiO2), pH, partial pressure of O2 in arterial blood (PaO2), partial pressure of CO2 in arterial blood (PaCO2), HCO3, oxygen saturation in arterial blood (SaO2), PaO2/FiO2, and peak inspiratory pressure were compared. Significant improvement in oxygenation was reflected by increases in SaO2, PaO2, and the PaO2/FiO2 ratio in the first 24 hours of HFPV. No significant increase in peak inspiratory pressure was documented by conversion from conventional ventilation to HFPV. No hemodynamic changes directly associated with HFPV were noted. Seven of ten patients failing conventional ventilation survived to hospital discharge after salvage therapy with HFPV. We advocate further studies of HFPV in non-burn patients with ARDS both as salvage therapy and as replacement for conventional ventilation for the initial treatment for ARDS.
尽管在危重症护理方面取得了多项进展，但患有严重成人呼吸窘迫综合征（ARDS）的患者仍可能耗尽传统通气的能力，这会导致呼吸衰竭和死亡。高频振荡通气（HFPV）最初用于抢救对传统通气难治的吸入烟雾损伤的烧伤患者，现已发展成为烧伤护理的标准。基于我们在烧伤患者中使用HFPV的经验，我们咨询了烧伤团队，为患有难治性呼吸衰竭的非烧伤外科重症监护病房患者提供抢救通气。在14个月的时间里，对10名因多种原因导致难治性ARDS的患者进行了治疗。进行了回顾性病历审查。在开始HFPV之前和之后24小时评估呼吸参数。比较了吸入氧分数（FiO2）、pH值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、HCO3、动脉血氧饱和度（SaO2）、PaO2/FiO2以及吸气峰压的平均值。在HFPV的前24小时内，SaO2、PaO2和PaO2/FiO2比值的增加反映了氧合的显著改善。从传统通气转换为HFPV后，未记录到吸气峰压有显著增加。未观察到与HFPV直接相关的血流动力学变化。10名传统通气失败的患者中有7名在接受HFPV抢救治疗后存活至出院。我们主张对非烧伤ARDS患者进一步研究HFPV，既作为抢救治疗，也作为替代传统通气用于ARDS的初始治疗。
