Musk Gabrielle C, Polglase Graeme R, Bunnell J Bert, Nitsos Ilias, Tingay David, Pillow J Jane
Animal Care Services, Faculty of Medicine Dentistry and Health Sciences, University of Western Australia, Perth, Australia.
The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Australia.
Pediatr Pulmonol. 2015 Dec;50(12):1286-93. doi: 10.1002/ppul.23187. Epub 2015 Mar 30.
Synchronised intermittent mandatory ventilation (SIMV) and high-frequency jet ventilation (HFJV) are accepted ventilatory strategies for treatment of respiratory distress syndrome (RDS) in preterm babies. We hypothesised that SIMV and HFJV both facilitate adequate oxygenation and ventilation but that HFJV is associated with less lung injury.
There were no differences in arterial oxygenation or partial pressure of carbon dioxide despite lower mean airway pressure during SIMV for most of the study. There were no consistent significant differences in end systolic and end diastolic PBF, lung injury data and static lung compliance.
Preterm lambs of anaesthetised ewes were instrumented, intubated and delivered by caesarean section after intratracheal suction and instillation of surfactant. Each lamb was managed for 3 hr according to a predetermined algorithm for ventilatory support consistent with open lung ventilation. Pulmonary blood flow (PBF) was measured continuously and pulsatility index was calculated. Ventilatory parameters were recorded and arterial blood gases were measured at intervals. At postmortem, in situ pressure-volume deflation curves were recorded, and bronchoalveolar lavage fluid and lung tissue were obtained to assess inflammation.
SIMV and HFJV have comparable clinical efficacy and ventilator pressure requirements when applied with a targeted lung volume recruitment strategy.
同步间歇指令通气（SIMV）和高频喷射通气（HFJV）是治疗早产儿呼吸窘迫综合征（RDS）公认的通气策略。我们假设SIMV和HFJV都能促进充分的氧合和通气，但HFJV与较少的肺损伤相关。
在研究的大部分时间里，尽管SIMV期间平均气道压力较低，但动脉氧合或二氧化碳分压并无差异。收缩末期和舒张末期肺血流（PBF）、肺损伤数据和静态肺顺应性方面也没有一致的显著差异。
对麻醉母羊的早产羔羊进行仪器植入、气管插管，并在气管内吸引和注入表面活性剂后通过剖宫产分娩。根据与肺开放通气一致的预定通气支持算法，对每只羔羊进行3小时的管理。连续测量肺血流（PBF）并计算搏动指数。记录通气参数并定期测量动脉血气。在尸检时，记录原位压力-容积放气曲线，并获取支气管肺泡灌洗液和肺组织以评估炎症。
当采用目标肺容积复张策略应用时，SIMV和HFJV具有相当的临床疗效和通气压力要求。
