U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
Crit Care Med. 2010 Oct;38(10):1970-7. doi: 10.1097/CCM.0b013e3181eb9d0b.
In select burn intensive care units, high-frequency percussive ventilation is preferentially used to provide mechanical ventilation in support of patients with acute lung injury, acute respiratory distress syndrome, and inhalation injury. However, we found an absence of prospective studies comparing high-frequency percussive ventilation with contemporary low-tidal volume ventilation strategies. The purpose of this study was to prospectively compare the two ventilator modalities in a burn intensive care unit setting.
Single-center, prospective, randomized, controlled clinical trial, comparing high-frequency percussive ventilation with low-tidal volume ventilation in patients admitted to our burn intensive care unit with respiratory failure.
A 16-bed burn intensive care unit at a tertiary military teaching hospital.
Adult patients ≥ 18 yrs of age requiring prolonged (> 24 hrs) mechanical ventilation were admitted to the burn intensive care unit. The study was conducted over a 3-yr period between April 2006 and May 2009. This trial was registered with ClinicalTrials.gov as NCT00351741.
Subjects were randomly assigned to receive mechanical ventilation through a high-frequency percussive ventilation-based strategy (n = 31) or a low-tidal volume ventilation-based strategy (n = 31).
At baseline, both the high-frequency percussive ventilation group and the low-tidal volume ventilation group had similar demographics to include median age (interquartile range) (28 yrs [23-45] vs. 33 yrs [24-46], p = nonsignificant), percentage of total body surface area burn (34 [20-52] vs. 34 [23-50], p = nonsignificant), and clinical diagnosis of inhalation injury (39% vs. 35%, p = nonsignificant). The primary outcome was ventilator-free days in the first 28 days after randomization. Intent-to-treat analysis revealed no significant difference between the high-frequency percussive ventilation and the low-tidal volume ventilation groups in mean (± sd) ventilator-free days (12 ± 9 vs. 11 ± 9, p = nonsignificant). No significant difference was detected between groups for any of the secondary outcome measures to include mortality except the need for "rescue" mode application (p = .02). Nine (29%) in the low-tidal volume ventilation arm did not meet predetermined oxygenation or ventilation goals and required transition to a rescue mode. By contrast, two in the high-frequency percussive ventilation arm (6%) required rescue.
A high-frequency percussive ventilation-based strategy resulted in similar clinical outcomes when compared with a low-tidal volume ventilation-based strategy in burn patients with respiratory failure. However, the low-tidal volume ventilation strategy failed to achieve ventilation and oxygenation goals in a higher percentage necessitating rescue ventilation.
在某些烧伤重症监护病房，高频喷射通气被优先用于支持急性肺损伤、急性呼吸窘迫综合征和吸入性损伤患者的机械通气。然而，我们发现缺乏将高频喷射通气与现代低潮气量通气策略进行前瞻性比较的研究。本研究旨在前瞻性比较两种通气模式在烧伤重症监护病房的应用。
单中心、前瞻性、随机、对照临床试验，比较高频喷射通气与低潮气量通气在呼吸衰竭患者中的应用，这些患者被收入我们的烧伤重症监护病房。
一家三级军队教学医院的 16 张烧伤重症监护病房。
年龄≥ 18 岁、需要长时间（> 24 小时）机械通气的成年患者被收入烧伤重症监护病房。研究于 2006 年 4 月至 2009 年 5 月期间进行，历时 3 年。本试验在 ClinicalTrials.gov 上注册，编号为 NCT00351741。
受试者随机分配接受高频喷射通气为基础的策略（n = 31）或低潮气量通气为基础的策略（n = 31）的机械通气。
在基线时，高频喷射通气组和低潮气量通气组的患者在年龄（中位数[四分位距]）（28 岁[23-45] 与 33 岁[24-46]，p = 非显著性）、总体表烧伤百分比（34%[20-52] 与 34%[23-50]，p = 非显著性）和吸入性损伤的临床诊断（39%与 35%，p = 非显著性）方面均具有相似的特征。主要结局是随机分组后 28 天内的无呼吸机天数。意向治疗分析显示，高频喷射通气组与低潮气量通气组在平均（±标准差）无呼吸机天数（12 ± 9 与 11 ± 9，p = 非显著性）方面无显著差异。两组之间在任何次要结局测量指标（包括死亡率）上均无显著差异，除了需要“抢救”模式应用（p =.02）。低潮气量通气组中有 9 例（29%）未达到预定的氧合或通气目标，需要转为抢救模式。相比之下，高频喷射通气组有 2 例（6%）需要抢救。
在呼吸衰竭的烧伤患者中，高频喷射通气为基础的策略与低潮气量通气为基础的策略相比，临床结局相似。然而，低潮气量通气策略未能达到通气和氧合目标，需要抢救性通气的比例更高。
