Fioretto José Roberto, Klefens Susiane Oliveira, Pires Rafaelle Fernandes, Kurokawa Cilmery Suemi, Carpi Mario Ferreira, Bonatto Rossano César, Moraes Marcos Aurélio, Ronchi Carlos Fernando
Departamento de Pediatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho" - Botucatu (SP), Brasil.
Faculdade de Educação Física e Fisioterapia, Universidade Federal de Uberlândia - Uberlândia (MG), Brasil.
Rev Bras Ter Intensiva. 2017 Oct-Dec;29(4):427-435. doi: 10.5935/0103-507X.20170067. Epub 2017 Dec 7.
To compare the effects of high-frequency oscillatory ventilation and conventional protective mechanical ventilation associated with the prone position on oxygenation, histology and pulmonary oxidative damage in an experimental model of acute lung injury.
Forty-five rabbits with tracheostomy and vascular access were underwent mechanical ventilation. Acute lung injury was induced by tracheal infusion of warm saline. Three experimental groups were formed: healthy animals + conventional protective mechanical ventilation, supine position (Control Group; n = 15); animals with acute lung injury + conventional protective mechanical ventilation, prone position (CMVG; n = 15); and animals with acute lung injury + high-frequency oscillatory ventilation, prone position (HFOG; n = 15). Ten minutes after the beginning of the specific ventilation of each group, arterial gasometry was collected, with this timepoint being called time zero, after which the animal was placed in prone position and remained in this position for 4 hours. Oxidative stress was evaluated by the total antioxidant performance assay. Pulmonary tissue injury was determined by histopathological score. The level of significance was 5%.
Both groups with acute lung injury showed worsening of oxygenation after induction of injury compared with the Control Group. After 4 hours, there was a significant improvement in oxygenation in the HFOG group compared with CMVG. Analysis of total antioxidant performance in plasma showed greater protection in HFOG. HFOG had a lower histopathological lesion score in lung tissue than CMVG.
High-frequency oscillatory ventilation, associated with prone position, improves oxygenation and attenuates oxidative damage and histopathological lung injury compared with conventional protective mechanical ventilation.
在急性肺损伤实验模型中，比较高频振荡通气与传统保护性机械通气联合俯卧位对氧合、组织学及肺氧化损伤的影响。
对45只行气管切开及建立血管通路的兔子进行机械通气。通过气管内注入温盐水诱导急性肺损伤。形成三个实验组：健康动物 + 传统保护性机械通气，仰卧位（对照组；n = 15）；急性肺损伤动物 + 传统保护性机械通气，俯卧位（CMVG组；n = 15）；急性肺损伤动物 + 高频振荡通气，俯卧位（HFOG组；n = 15）。每组开始特定通气10分钟后，采集动脉血气分析，此时点称为零时刻，之后将动物置于俯卧位并保持该体位4小时。通过总抗氧化能力测定评估氧化应激。通过组织病理学评分确定肺组织损伤情况。显著性水平为5%。
与对照组相比，两组急性肺损伤动物在损伤诱导后氧合均恶化。4小时后，与CMVG组相比，HFOG组氧合有显著改善。血浆总抗氧化能力分析显示HFOG组具有更好的保护作用。HFOG组肺组织的组织病理学损伤评分低于CMVG组。
与传统保护性机械通气相比，高频振荡通气联合俯卧位可改善氧合，减轻氧化损伤及肺组织病理学损伤。
