Department of Critical Care Medicine and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
Crit Care Med. 2011 Dec;39(12):2631-44. doi: 10.1097/CCM.0b013e318226675e.
High-frequency oscillation is used for adults with acute lung injury/acute respiratory distress syndrome. Given the uncertain benefits, our objective was to describe contemporary patient selection, high-frequency oscillation utilization, and outcomes.
Utilization review.
Ten academic centers (Ontario, Canada; January 1, 2005-January 31, 2007).
We included 190 consecutive adults treated with high-frequency oscillation and retrospectively abstracted data on patient demographics, gas exchange, hemodynamics, settings during conventional ventilation and high-frequency oscillation, adjunctive therapies, and outcomes. We used logistic regression to explore associations with oxygenation response and hemodynamic and ventilatory complications (2 hrs after high-frequency oscillation initiation) and mortality. Continuous data are reported as mean (sd) or median (quartile 1, quartile 3).
None.
Patients (60.0% male; mean age, 52; sd 17) had predominantly acute lung injury/acute respiratory distress syndrome (89.8%) and were severely ill (mean Acute Physiology and Chronic Health Evaluation II score, 28; sd, 9) and hypoxemic (mean Pao2/Fio2, 80; sd, 42). High-frequency oscillation was started a median of 2 (1, 8) days after intubation and continued for a median of 3 (2, 7) days. During high-frequency oscillation, adjunctive treatments (neuromuscular blockade, 75.6%; recruitment maneuvers, 49.5%; nitric oxide, 34.0%; steroids, 63.1%) and new barotrauma or chest tube placement (23.5%) were common. Ten patients (5.3%) had technical complications; five required a new ventilator. Reasons for stopping high-frequency oscillation included death or withdrawal of life support (39.1%), significant improvement in respiratory failure (37.6%), and inadequate improvement (23.3%). One hundred and twenty-eight of 189 patients died in hospital. Most (62.5%) had a positive oxygenation response after 2 hrs of high-frequency oscillation (mean absolute increase in PaO₂/FiO₂, 22 [SD, 54]; 95% confidence interval of mean 14-31). A minority had lower PaO₂/FiO₂ (32.5%) or a hemodynamic (27.5%) or ventilatory (30.5%) complication. Older age, Acute Physiology and Chronic Health Evaluation II score, and Paco2 before high-frequency oscillation were independently associated with mortality.
Most patients treated with high-frequency oscillation have acute respiratory distress syndrome and severe hypoxemia that modestly improves 2 hrs after high-frequency oscillation application. However, oxygenation worsens in some patients, complications are common, and mortality is high.
高频振荡通气用于成人急性肺损伤/急性呼吸窘迫综合征。鉴于其不确定的益处，我们的目的是描述当前的患者选择、高频振荡的应用以及结局。
利用审查。
十个学术中心（加拿大安大略省；2005 年 1 月 1 日至 2007 年 1 月 31 日）。
我们纳入了 190 例连续接受高频振荡治疗的成人，并回顾性地提取了患者人口统计学、气体交换、血流动力学、常规通气和高频振荡期间的设置、辅助治疗和结局的数据。我们使用逻辑回归来探讨与氧合反应以及血流动力学和通气并发症（高频振荡开始后 2 小时）和死亡率的关联。连续数据以平均值（标准差）或中位数（第 1 四分位数、第 3 四分位数）表示。
无。
患者（60.0%为男性；平均年龄 52 岁，标准差 17 岁）主要患有急性肺损伤/急性呼吸窘迫综合征（89.8%），且病情严重（平均急性生理学和慢性健康评估Ⅱ评分 28，标准差 9）和低氧血症（平均 PaO2/Fio2 80，标准差 42）。高频振荡开始的中位数为插管后 2（1，8）天，持续中位数为 3（2，7）天。在高频振荡期间，辅助治疗（神经肌肉阻滞剂，75.6%；复张手法，49.5%；一氧化氮，34.0%；类固醇，63.1%）和新的气压伤或胸管放置（23.5%）很常见。10 名患者（5.3%）出现技术并发症；5 名患者需要更换呼吸机。停止高频振荡的原因包括死亡或停止生命支持（39.1%）、呼吸衰竭显著改善（37.6%）和改善不充分（23.3%）。189 例患者中有 128 例在医院死亡。大多数（62.5%）在高频振荡开始后 2 小时有阳性氧合反应（平均绝对 PaO2/Fio2 增加 22[标准差 54]；95%置信区间的平均值为 14-31）。少数患者的 PaO2/Fio2 更低（32.5%）或出现血流动力学（27.5%）或通气（30.5%）并发症。年龄较大、急性生理学和慢性健康评估Ⅱ评分以及高频振荡前的 Paco2 与死亡率独立相关。
接受高频振荡治疗的大多数患者患有急性呼吸窘迫综合征和严重低氧血症，在高频振荡应用后 2 小时氧合略有改善。然而，一些患者的氧合恶化，并发症常见，死亡率高。
