De Jaegere Anne, van Veenendaal Mariëtte B, Michiels Agnes, van Kaam Anton H
Department of Neonatology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Am J Respir Crit Care Med. 2006 Sep 15;174(6):639-45. doi: 10.1164/rccm.200603-351OC. Epub 2006 Jun 8.
Changes in oxygenation are often used to guide the recruitment procedure during open lung high-frequency ventilation in preterm infants. However, data on the feasibility and safety of this approach in daily clinical practice are limited.
To prospectively collect data on ventilator settings, gas exchange, and circulatory parameters before and after surfactant therapy during open lung high-frequency ventilation.
In 103 preterm infants with respiratory distress syndrome, the opening, closing, and optimal pressures were determined during high-frequency ventilation by increasing and decreasing stepwise the continuous distending pressure, defining optimal recruitment as adequate oxygenation using a fraction of inspired oxygen not exceeding 0.25. This procedure was repeated after each surfactant treatment.
The mean presurfactant opening and optimal continuous distending pressures were, respectively, 20.5 +/- 4.3 and 14.0 +/- 4.0 cm H2O, with a fraction of inspired oxygen of 0.24 +/- 0.04. Surfactant treatment enabled a reduction in the mean optimal pressure of almost 6 cm H2O without compromising oxygenation. Blood pressure and heart rate remained stable and no air leaks were observed during the recruitment procedures. The mortality rate and the incidence of severe intracranial hemorrhage or periventricular leukomalacia and chronic lung disease at 36 wk were comparable to previously reported data.
Open lung high-frequency ventilation using oxygenation to guide the recruitment process is feasible and safe in preterm infants and enables a reduction of the fraction of inspired oxygen below 0.25 in the majority of preterm infants with respiratory distress syndrome.
在早产儿的肺开放高频通气期间，氧合变化常被用于指导复张操作。然而，在日常临床实践中，关于这种方法的可行性和安全性的数据有限。
前瞻性收集在肺开放高频通气期间，表面活性剂治疗前后的呼吸机设置、气体交换和循环参数的数据。
在103例患有呼吸窘迫综合征的早产儿中，通过逐步增加和降低持续扩张压力来确定高频通气期间的开放压、关闭压和最佳压力，将使用不超过0.25的吸入氧分数实现充分氧合定义为最佳复张。每次表面活性剂治疗后重复此操作。
表面活性剂治疗前的平均开放压和最佳持续扩张压力分别为20.5±4.3和14.0±4.0 cmH₂O，吸入氧分数为0.24±0.04。表面活性剂治疗能够使平均最佳压力降低近6 cmH₂O，而不影响氧合。在复张过程中，血压和心率保持稳定，未观察到气胸。36周时的死亡率、严重颅内出血或脑室周围白质软化症以及慢性肺病的发生率与先前报道的数据相当。
在早产儿中，使用氧合指导复张过程的肺开放高频通气是可行且安全的，并且能够使大多数患有呼吸窘迫综合征的早产儿的吸入氧分数降至0.25以下。
