成人急性呼吸窘迫综合征的高频振荡通气：过去、现在与未来
High-Frequency Oscillatory Ventilation in Adults With ARDS: Past, Present, and Future.
作者信息
Sklar Michael C, Fan Eddy, Goligher Ewan C
机构信息
Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
出版信息
Chest. 2017 Dec;152(6):1306-1317. doi: 10.1016/j.chest.2017.06.025. Epub 2017 Jul 3.
High-frequency oscillatory ventilation (HFOV) is a unique mode of mechanical ventilation that uses nonconventional gas exchange mechanisms to deliver ventilation at very low tidal volumes and high frequencies. The properties of HFOV make it a potentially ideal mode to prevent ventilator-induced lung injury in patients with ARDS. Despite a compelling physiological basis and promising experimental data, large randomized controlled trials have not detected an improvement in survival with the use of HFOV, and its use as an early lung-protective strategy in patients with ARDS may be harmful. Nevertheless, HFOV still has an important potential role in the management of refractory hypoxemia. Careful attention should be paid to right ventricular function and lung stress when applying HFOV. This review discusses the physiological principles, clinical evidence, practical applications, and future prospects for the use of HFOV in patients with ARDS.
高频振荡通气（HFOV）是一种独特的机械通气模式，它利用非常规气体交换机制，以极低的潮气量和高频进行通气。HFOV的特性使其成为预防急性呼吸窘迫综合征（ARDS）患者呼吸机诱导性肺损伤的潜在理想模式。尽管有令人信服的生理基础和有前景的实验数据，但大型随机对照试验并未发现使用HFOV可提高生存率，而且将其作为ARDS患者的早期肺保护策略可能有害。然而，HFOV在难治性低氧血症的管理中仍具有重要的潜在作用。应用HFOV时应密切关注右心室功能和肺应激。本文综述了HFOV在ARDS患者中的生理原理、临床证据、实际应用及未来前景。
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