Cukurova University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Adana, Turkey.
Indian J Pediatr. 2009 Sep;76(9):921-7. doi: 10.1007/s12098-009-0151-9. Epub 2009 May 27.
To evaluate the effectiveness of HFOV in pediatric patients with acute respiratory distress syndrome.
In this retrospective study, we reviewed all 20 pediatric patients, who were consecutively ventilated with HFOV in the pediatric intensive care unit of a tertiary medical center, from January 2006 to February 2007.
A total of 20 patients were enrolled. The median age of the subjects was 70 (3-168) months; 10 were male. All patients received conventional ventilation before HFOV. After initiation of HFOV, there was an immediate and sustained increase in PaO(2)/FiO(2) ratio. The PaO(2)/FiO(2) ratio was elevated and OI was decreased significantly after 10-20 minutes and maintained for at least 48 hours (p= 0.03, both). Thirteen of the 20 patients were successfully weaned. No significant change in the mean arterial pressure and heart rate was noted after HFOV. Overall survival rate was 65%. Of 20 patients, 11 patients suffered from extrapulmonary ARDS (ARDSexp) and 9 from pulmonary ARDS (ARDSp). When HFOV was initiated, there was significant increase in PaO(2)/FiO(2) and decrease in OI in ARDSexp compared to ARDSp (p= 0.03, both). Also mortality rate was significantly lower in patients with ARDSexp (9% vs.66%), (p= 0.01).
In our study, HFOV was effective in oxygenation and seems to be safe for pediatric ARDS patients. HFOV affected ARDSp and ARDSexp paediatric patients differently. However prospective, randomized controlled trials are needed to identify its benefits over conventional modes of mechanical ventilation.
评估高频振荡通气（HFOV）在小儿急性呼吸窘迫综合征（ARDS）患者中的疗效。
本回顾性研究纳入了 2006 年 1 月至 2007 年 2 月期间在一家三级医疗中心的儿科重症监护病房中连续接受 HFOV 通气的 20 例儿科患者。
共纳入 20 例患者。患者的中位年龄为 70（3-168）月龄；其中 10 例为男性。所有患者在接受 HFOV 之前均接受了常规通气。在开始 HFOV 后，PaO2/FiO2 比立即且持续升高。在 10-20 分钟后，PaO2/FiO2 比显著升高，氧合指数（OI）显著降低，并且至少维持 48 小时（p=0.03，均）。20 例患者中有 13 例成功撤机。HFOV 后平均动脉压和心率无显著变化。总的存活率为 65%。20 例患者中，11 例为肺外源性 ARDS（ARDSexp），9 例为肺源性 ARDS（ARDSp）。在开始 HFOV 时，ARDSexp 患者的 PaO2/FiO2 比显著升高，OI 显著降低，与 ARDSp 患者相比差异有统计学意义（p=0.03，均）。此外，ARDSexp 患者的死亡率显著低于 ARDSp 患者（9% vs. 66%）（p=0.01）。
在本研究中，HFOV 在氧合方面有效，似乎对小儿 ARDS 患者是安全的。HFOV 对 ARDSp 和 ARDSexp 患儿的影响不同。然而，需要前瞻性、随机对照试验来确定其相对于常规机械通气模式的益处。
