Michaels Andrew J, Hill Jon G, Sperley Bernie P, Young Brian P, Ogston Tawyna L, Wiles Connor L, Rycus Peter, Shanks Tanya R, Long William B, Morgan Lori J, Bartlett Robert H
From the Legacy Emanuel Medical Center and Pacific Integration, Portland Oregon, University of Michigan Medical Center, Ann Arbor, Michigan.
ASAIO J. 2015 May-Jun;61(3):345-9. doi: 10.1097/MAT.0000000000000196.
Historically, patients on extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome have received ventilatory "lung rest" with conventional or high-frequency oscillating ventilators. We present a series of adults treated with high-frequency percussive ventilation (HFPV) to enhance recovery and recruitment during ECMO. Adult respiratory patients, treated between January 2009 and December 2012 were cared for with a combination of standard ECMO practices and a protocol of recruitment strategies, including HFPV. Data are reported as mean ± standard error of the mean, percentage, or median. Comparisons are made by χ for categorical variables and by t-test and Mann-Whitney test for continuous variables. Significance is noted at the 95% confidence level (p < 0.05). There were 39 HFPV patients. They were 39.9 ± 2.2 years of age and had 3.0 ± 0.37 days of mechanical ventilation before the initiation of ECMO. Their pre-ECMO PaO2 to FiO2 ratio (PF ratio) was 52.3 ± 3.0 and their pCO2 was 50.22 ± 2.4. HFPV patients required a mean of 143.1 ± 17.6 hours and a median of 106 hours (range 45.75-350.25) of ECMO support and had a 62% survival to discharge. The post-ECMO PF ratio in the HFPV cohort was 301.8 ± 16.7. A protocolized practice of active recruitment that includes HFPV is associated with reduced duration of ECMO support in adults with respiratory failure.
从历史上看，患有急性呼吸窘迫综合征并接受体外膜肺氧合（ECMO）治疗的患者一直使用传统或高频振荡呼吸机进行通气“肺休息”。我们报告了一系列接受高频震荡通气（HFPV）治疗的成年患者，以促进ECMO期间的恢复和肺复张。对2009年1月至2012年12月期间接受治疗的成年呼吸患者采用标准ECMO治疗方法与包括HFPV在内的肺复张策略方案相结合进行护理。数据报告为均值±均值标准误差、百分比或中位数。分类变量采用χ检验进行比较，连续变量采用t检验和曼-惠特尼检验进行比较。显著性水平设定为95%置信区间（p<0.05）。共有39例接受HFPV治疗的患者。他们的年龄为39.9±2.2岁，在开始ECMO之前接受了3.0±0.37天的机械通气。他们在ECMO前的氧合指数（PF比值）为52.3±3.0，二氧化碳分压为50.22±2.4。接受HFPV治疗的患者平均需要143.1±17.6小时的ECMO支持，中位数为106小时（范围45.75 - 350.25），出院生存率为62%。HFPV组患者在ECMO后的PF比值为301.8±16.7。包括HFPV在内的积极肺复张方案化实践与呼吸衰竭成年患者ECMO支持时间的缩短相关。
