Spapen Herbert, Borremans Marianne, Diltoer Marc, Gorp Viola Van, Nguyen Duc Nam, Honoré Patrick M
Department of Intensive Care, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):65-70. doi: 10.4103/0970-9185.125706.
Few studies have investigated high-frequency percussive ventilation (HFPV) in adult patients with acute respiratory distress syndrome (ARDS).
We retrospectively analyzed data from critically ill-patients with moderate and severe ARDS who received HFPV. Ventilation and oxygenation were governed according to a predefined protocol. HFPV was continued until patients could be switched to conventional ventilation.
A total of 42 patients (20 with pneumonia-related ARDS and 22 non-septic ARDS cases) were evaluable. Baseline demographic characteristics, severity of illness, lung injury score; pH and respiratory variables were comparable between pneumonia and non-sepsis-related ARDS. Within 24 h, HFPV restored normal pH and PaCO2 and considerably improved oxygenation. Oxygenation improved more in non-septic than in pneumonia-related ARDS. Patients with pneumonia-induced ARDS also remained longer HFPV-dependent (7.0 vs. 4.9 days; P < 0.05). Mortality at 30 days was significantly higher in pneumonia-related than in non-sepsis-related ARDS (50% vs. 18%; P = 0.01).
HFPV caused rapid and sustained improvement of oxygenation and ventilation in patients with moderate to severe ARDS. Less improved oxygenation, longer ventilator dependency and worse survival were observed in pneumonia-related ARDS.
很少有研究调查高频振荡通气（HFPV）在成人急性呼吸窘迫综合征（ARDS）患者中的应用。
我们回顾性分析了接受HFPV的中重度ARDS重症患者的数据。通气和氧合按照预定义方案进行控制。持续进行HFPV，直到患者能够转换为传统通气。
共有42例患者（20例肺炎相关性ARDS和22例非脓毒症性ARDS病例）可进行评估。肺炎相关性ARDS和非脓毒症相关性ARDS在基线人口统计学特征、疾病严重程度、肺损伤评分、pH值和呼吸变量方面具有可比性。在24小时内，HFPV恢复了正常pH值和PaCO2，并显著改善了氧合。非脓毒症性ARDS的氧合改善比肺炎相关性ARDS更明显。肺炎诱发的ARDS患者对HFPV的依赖时间也更长（7.0天对4.9天；P<0.05）。肺炎相关性ARDS的30天死亡率显著高于非脓毒症相关性ARDS（50%对18%；P=0.01）。
HFPV可使中重度ARDS患者的氧合和通气迅速且持续改善。肺炎相关性ARDS的氧合改善较少、呼吸机依赖时间更长且生存率更差。
