高频脉冲通气和低 FiO(2)。

High frequency percussive ventilation and low FiO(2).

机构信息

Division of Plastic and Reconstructive Surgery, Department of Surgery and Department of Anesthesiology, Los Angeles County + University of Southern California, Keck School of Medicine, Los Angeles, CA, United States.

出版信息

Burns. 2012 Nov;38(7):984-91. doi: 10.1016/j.burns.2012.05.026. Epub 2012 Jul 4.

DOI:10.1016/j.burns.2012.05.026

PMID:22766403

Abstract

BACKGROUND

High-frequency percussive ventilation (HFPV) is an effective rescue therapy in ventilated patients with acute lung injury. High levels of inspired oxygen (FiO(2)) are toxic to the lungs. The objective of this study was to review a low FiO(2) (0.25)/HFPV protocol as a protective strategy in burn patients receiving mechanical ventilation greater than 10 days.

METHODS

A single-center, retrospective study in burn patients between December 2002 and May 2005 at the LAC+USC Burn Center. Demographic and physiologic data were recorded from time of admission to extubation, 4 weeks, or death.

RESULTS

32 subjects were included in this study, 1 patient failed the protocol. 23 of 32 (72%) patients were men and mean age was 46±15 years. Average TBSA burn was 30±20 with 9 of 32 (28%) having >40% TBSA involved. Average burn index was 76±21. 22 of 32 (69%) had inhalation injury and 23 of 32 (72%) had significant comorbidities. Average ventilator parameters included ventilator days 24±12, FiO(2) 0.28±0.03, PaO(2) 107±15 Torr, PaCO(2) 42±4 Torr, and PaO(2)/FiO(2) ratio 395±69. 16 of 32 (50%) patients developed pneumonia and 9 of 32 (28%) died. No patient developed ARDS, barotrauma, or died from respiratory failure. There was no association between inhalation injury and mortality in this group of patients.

CONCLUSION

A low FiO(2)/HFPV protocol is a safe and effective way to ventilate critically ill burn patients. Reducing the oxidative stress of high inspired oxygen levels may improve outcome.

摘要

背景

高频喷射通气（HFPV）是治疗急性肺损伤机械通气患者的一种有效抢救治疗方法。高浓度吸入氧（FiO₂）对肺部有毒。本研究的目的是回顾低 FiO₂（0.25）/HFPV 方案作为机械通气大于 10 天的烧伤患者的保护性策略。

方法

这是一项于 2002 年 12 月至 2005 年 5 月在 LAC+USC 烧伤中心进行的烧伤患者单中心回顾性研究。从入院到拔管、4 周或死亡时记录人口统计学和生理数据。

结果

本研究共纳入 32 例患者，1 例患者未按方案进行。32 例患者中 23 例（72%）为男性，平均年龄为 46±15 岁。平均 TBSA 烧伤为 30±20，其中 9 例（28%）>40% TBSA 受累。平均烧伤指数为 76±21。22 例（69%）有吸入性损伤，23 例（72%）有严重合并症。平均呼吸机参数包括呼吸机使用天数 24±12、FiO₂0.28±0.03、PaO₂107±15 Torr、PaCO₂42±4 Torr、PaO₂/FiO₂比值 395±69。32 例患者中 16 例（50%）发生肺炎，9 例（28%）死亡。无患者发生 ARDS、气压伤或因呼吸衰竭死亡。在这组患者中，吸入性损伤与死亡率之间没有关联。