Niwa T, Hasegawa R, Ryuge M, Kawase M, Kondoh Y, Taniguchi H
Department of Emergency and Intensive Care Medicine, Intensive Care Unit, Tosei General Hospital, Seto, Japan.
Anaesth Intensive Care. 2011 Nov;39(6):1111-9. doi: 10.1177/0310057X1103900539.
High frequency oscillatory ventilation has been shown to improve oxygenation of patients with severe respiratory failure. This prospective study examined the potential benefits and risks of the latest generation high frequency oscillatory ventilator (R100, Metran, Saitama, Japan), initiated when the target oxygenation could not be achieved by conventional mechanical ventilation in adult patients with severe hypoxaemic respiratory failure. Thirty-six patients with severe respiratory failure treated with the R100 high frequency oscillatory ventilator were considered. Pneumonia and exacerbation of interstitial pneumonia were the main causes of respiratory failure. The median time on conventional mechanical ventilation or airway pressure release ventilation prior to high frequency oscillatory ventilation was 9.3 hours (interquartile range 4.8 to 25). PaO2/FiO2 at 24 hours after initiation of high frequency oscillatory ventilation was significantly better than the PaO2/FiO2 at baseline (151.2 +/- 61.2 vs. 99.5 +/- 50.0, P = 0.0001). Refractory hypoxaemia within 24 hours was associated with a high risk of mortality (P = 0.0092) and 23 patients (64%), including 11 patients with exacerbation of interstitial pneumonia, died by 30 days. Of the 36 patients included in the study (including one who had developed pneumothorax before high frequency oscillatory ventilation), 12 (33%) developed barotrauma during the course of their intensive care unit stay. In the multivariate analysis, only exacerbation of interstitial pneumonia was a significant risk factor for barotrauma. In summary, the latest generation high frequency oscillatory ventilator could improve oxygenation in adult patients with life-threatening hypoxaemic respiratory failure but the incidence of barotrauma was substantial.
高频振荡通气已被证明可改善严重呼吸衰竭患者的氧合。这项前瞻性研究探讨了最新一代高频振荡呼吸机（R100，日本埼玉县Metran公司）的潜在益处和风险，该研究针对成年严重低氧血症性呼吸衰竭患者，在常规机械通气无法实现目标氧合时启动。研究纳入了36例接受R100高频振荡呼吸机治疗的严重呼吸衰竭患者。肺炎和间质性肺炎加重是呼吸衰竭的主要原因。在进行高频振荡通气之前，患者接受常规机械通气或气道压力释放通气的中位时间为9.3小时（四分位间距为4.8至25小时）。高频振荡通气开始后24小时的动脉血氧分压/吸入氧分数值（PaO2/FiO2）显著优于基线时的PaO2/FiO2（151.2±61.2 vs. 99.5±50.0，P = 0.0001）。24小时内的难治性低氧血症与高死亡风险相关（P = 0.0092），23例患者（64%）在30天内死亡，其中包括11例间质性肺炎加重的患者。在纳入研究的36例患者中（包括1例在高频振荡通气前已发生气胸的患者），12例（33%）在重症监护病房住院期间发生了气压伤。多因素分析显示，只有间质性肺炎加重是气压伤的显著危险因素。总之，最新一代高频振荡呼吸机可改善成年危及生命的低氧血症性呼吸衰竭患者的氧合，但气压伤的发生率较高。
