Anesthesiolgy and Critical Care Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France.
Crit Care. 2011;15(5):R259. doi: 10.1186/cc10521. Epub 2011 Oct 28.
Experience with high-frequency oscillatory ventilation (HFOV) after congenital cardiac surgery is limited despite evidence about reduction in pulmonary vascular resistance after the Fontan procedure. HFOV is recommended in adults and children with acute respiratory distress syndrome. The aim of the present study was to assess associations between commencement of HFOV on the day of surgery and length of mechanical ventilation, length of Intensive Care Unit (ICU) stay and mortality in neonates and infants with respiratory distress following cardiac surgery.
A logistic regression model was used to develop a propensity score, which accounted for the probability of being switched from conventional mechanical ventilation (CMV) to HFOV on the day of surgery. It included baseline characteristics, type of procedure and postoperative variables, and was used to match each patient with HFOV with a control patient, in whom CMV was used exclusively. Length of mechanical ventilation, ICU stay and mortality rates were compared in the matched set.
Overall, 3,549 neonates and infants underwent cardiac surgery from January 2001 through June 2010, 120 patients were switched to HFOV and matched with 120 controls. After adjustment for the delay to sternal closure, duration of renal replacement therapy, occurrence of pulmonary hypertension and year of surgery, the probability of successful weaning over time and the probability of ICU delivery over time were significantly higher in patients with HFOV, adjusted hazard ratios and 95% confidence intervals: 1.63, 1.17 to 2.26 (P = 0.004). and 1.65, 95% confidence intervals: 1.20 to 2.28 (P = 0.002) respectively. No association was found with mortality.
When commenced on the day of surgery in neonates and infants with respiratory distress following cardiac surgery, HFOV was associated with shorter lengths of mechanical ventilation and ICU stay than CMV.
尽管 Fontan 手术后肺血管阻力降低的证据有限，但在先天性心脏手术后使用高频振荡通气（HFOV）的经验有限。HFOV 推荐用于患有急性呼吸窘迫综合征的成人和儿童。本研究的目的是评估心脏手术后呼吸窘迫的新生儿和婴儿在手术当天开始 HFOV 与机械通气时间、重症监护病房（ICU）住院时间和死亡率之间的关系。
使用逻辑回归模型制定倾向评分，该评分考虑了在手术当天从常规机械通气（CMV）切换到 HFOV 的概率。它包括基线特征、手术类型和术后变量，并用于将每个接受 HFOV 的患者与仅接受 CMV 的对照患者相匹配。在匹配组中比较机械通气时间、ICU 住院时间和死亡率。
2001 年 1 月至 2010 年 6 月期间，共有 3549 名新生儿和婴儿接受了心脏手术，120 名患者转为 HFOV，并与 120 名对照患者相匹配。在调整了胸骨闭合延迟、肾脏替代治疗时间、肺动脉高压发生和手术年份后，HFOV 患者的成功撤机率和 ICU 分娩率随时间的调整后优势比和 95%置信区间分别显著更高：1.63，1.17 至 2.26（P = 0.004）和 1.65，95%置信区间：1.20 至 2.28（P = 0.002）。与死亡率无关联。
在心脏手术后呼吸窘迫的新生儿和婴儿中，在手术当天开始使用 HFOV 与 CMV 相比，机械通气时间和 ICU 住院时间更短。
