Dept of Neonatology (H3-214), Emma Children's Hospital AMC, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Eur Respir J. 2012 Aug;40(2):479-84. doi: 10.1183/09031936.00138311. Epub 2012 Feb 23.
We determined the effect of lung recruitment and oscillation amplitude on regional oscillation volume and functional residual capacity (FRC) in high-frequency oscillatory ventilation (HFOV) used in pre-term infants with respiratory distress syndrome (RDS). Changes in lung volume, oscillation volume and carbon dioxide levels were recorded in 10 infants during a stepwise recruitment procedure, and an increase in pressure amplitude of 5 cmH(2)O was measured using electrical impedance tomography and transcutaneous monitoring. The pressures at maximal respiratory system compliance, maximal oscillation volume and minimal carbon dioxide levels were determined. Impedance data were analysed for the chest cross-section and predefined regions of interest. Despite the fixed pressure amplitude, the oscillation volume changed during the incremental pressure steps following a parabolic pattern, with an inverse relationship to the carbon dioxide pressures. The pressures corresponding with maximal compliance, maximal oscillation volume and minimal carbon dioxide were similar and highly correlated. Regional analysis showed similar findings. The increase in pressure amplitude resulted in increased oscillation volumes and decreased carbon dioxide levels, while FRC remained unchanged. In HFV pre-term infants with RDS, oscillation volumes are closely related to the position of ventilation in the pressure-volume envelope and the applied pressure amplitude. Changes in pressure amplitude do not seem to affect FRC.
我们在患有呼吸窘迫综合征（RDS）的早产儿中使用高频振荡通气（HFOV），确定了肺复张和振荡幅度对局部振荡容积和功能残气量（FRC）的影响。在逐步复张过程中，10 名婴儿的肺容积、振荡容积和二氧化碳水平变化被记录下来，并且使用电阻抗断层成像和经皮监测测量了压力幅度增加 5 cmH(2)O。确定了最大呼吸系统顺应性、最大振荡容积和最小二氧化碳水平的压力。对胸部横截面积和预定义感兴趣区域的阻抗数据进行了分析。尽管压力幅度固定，但在递增压力步骤中，振荡体积呈现抛物线模式变化，与二氧化碳压力呈反比。与最大顺应性、最大振荡容积和最小二氧化碳对应的压力相似且高度相关。区域分析显示出类似的发现。压力幅度增加导致振荡体积增加和二氧化碳水平降低，而 FRC 保持不变。在患有 RDS 的早产儿高频通气中，振荡体积与通气在压力-容积包络中的位置和应用的压力幅度密切相关。压力幅度的变化似乎不会影响 FRC。
