Kao Kuo-Chin, Tsai Ying-Huang, Wu Yao-Kuang, Huang Ching-Tzu, Shih Mei-Ju, Huang Chung-Chi
Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Trauma. 2006 Oct;61(4):837-43. doi: 10.1097/01.ta.0000235290.00606.84.
Numerous studies have suggested that high-frequency oscillatory ventilation (HFOV) used as rescue therapy may improve oxygenation in acute respiratory distress syndrome (ARDS) patients. The purpose of this study is to analyze the efficacy and safety of HFOV in surgical patients with ARDS.
A total of 16 surgical ARDS patients with severe oxygenation failure received HFOV, despite aggressive conventional mechanical ventilatory support. Mean airway pressure was initially set 3 to 5 cm H2O higher than that for conventional ventilation and was subsequently adjusted to maintain oxygen saturation > or = 90% and FiO2 < or =0.6. Oxygenation, ventilation, and hemodynamic parameters were measured during conventional ventilation before initiating HFOV and during HFOV support for a total of 40 hours. Other outcome measures included duration of HFOV, successful weaning rate, cause of failure, complications, survival rate, and cause of death.
There was a considerable increase in Pao2/FiO2 ratio after 30 minutes, and this increase was maintained after 12 hours of HFOV throughout the study. There was a significant decrease in oxygenation index after 24 hours of HFOV support. There was no significant change in blood pressure associated with initiation and administration of HFOV. The successful weaning rate from HFOV to conventional ventilation was 75%. The intensive care unit survival rate was 43.8% and hospital survival rate was 37.5%.
High-frequency oscillatory ventilation was effective and safe in correcting oxygenation failure associated with ARDS in surgical patients. Future research is warranted to identify the suitable patients, timing, and optimal strategy for applying HFOV.
大量研究表明，高频振荡通气（HFOV）作为挽救治疗手段，可能改善急性呼吸窘迫综合征（ARDS）患者的氧合情况。本研究旨在分析HFOV用于外科ARDS患者的疗效和安全性。
尽管给予积极的传统机械通气支持，仍有16例严重氧合衰竭的外科ARDS患者接受了HFOV治疗。初始平均气道压设定为比传统通气时高3至5 cm H₂O，随后进行调整以维持氧饱和度≥90%且吸入氧浓度（FiO₂）≤0.6。在开始HFOV之前的传统通气期间以及HFOV支持的总共40小时内，测量氧合、通气和血流动力学参数。其他结局指标包括HFOV持续时间、成功脱机率、失败原因、并发症、生存率和死亡原因。
30分钟后动脉血氧分压/吸入氧浓度（Pao₂/FiO₂）比值显著升高，且在整个研究中HFOV 12小时后该升高仍持续。HFOV支持24小时后氧合指数显著降低。HFOV启动和应用过程中血压无显著变化。从HFOV转为传统通气的成功脱机率为75%。重症监护病房生存率为43.8%，医院生存率为37.5%。
高频振荡通气在纠正外科患者ARDS相关的氧合衰竭方面有效且安全。有必要开展进一步研究以确定适合应用HFOV的患者、时机和最佳策略。
