Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Department of Respiratory Therapy, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
J Intensive Care Med. 2020 Jun;35(6):583-587. doi: 10.1177/0885066618769596. Epub 2018 Apr 22.
Morbidly obese patients with respiratory failure who do not improve on conventional mechanical ventilation (CMV) often undergo rescue therapy with extracorporeal membrane oxygenation (ECMO). We describe our experience with high-frequency percussive ventilation (HFPV) as a rescue modality.
In a retrospective analysis from 2009 to 2016, 12 morbidly obese patients underwent HFPV after failing to wean from CMV. Data were collected regarding demographics, cause of respiratory failure, ventilation settings, and hospital course outcomes. Our end point data were pre- and post-HFPV partial pressure of arterial oxygen and PaO to fraction of inspired oxygen (PF) ratios measured at initiation, 2, and 24 hours.
Twelve morbidly obese patients required HFPV for respiratory failure. Causes of respiratory failure overlapped and included cardiogenic pulmonary edema (n = 8), pneumonia (n = 5), septic shock (n = 5), and asthma (n = 1). After HFPV initiation, mean fraction of inspired oxygen FiO was tapered from 98% to 82% and 66% at 2 and 24 hours, respectively. Mean PaO increased from 60.9 mm Hg before HFPV to 175.1 mm Hg ( < .05) at initiation of HFPV, then sustained at 129.5 mm Hg ( < .05) and 88.1 mm Hg ( < .005) at 2 and 24 hours, respectively. Mean PF ratio improved from 66.1 before HFPV to 180.3 ( < .05), 181.0 ( < .05) and 148.9 ( < .0005) at initiation, 2, and 24 hours, respectively. The improvement in mean PaO and PF ratios was durable at 24 hours whether or not the patient was returned to CMV (n = 10) or remained on HFPV (n = 2). Survival to discharge was 66.7%.
In our cohort of morbidly obese patients, HFPV was successfully utilized as a rescue therapy precluding the need for ECMO. Despite our small sample size, HFPV should be considered as a rescue therapy in morbidly obese patients failing CMV prior to the initiation of ECMO. Our retrospective analysis supports consideration for HFPV as another form of rescue therapy for obese patients with refractory hypoxemia and respiratory failure who are not improving with CMV.
患有呼吸衰竭的病态肥胖患者在常规机械通气（CMV）治疗后未见改善，常需接受体外膜氧合（ECMO）进行抢救治疗。我们描述了高频喷射通气（HFPV）作为抢救手段的应用经验。
在 2009 年至 2016 年的回顾性分析中，12 例病态肥胖患者在无法从 CMV 脱机后接受 HFPV 治疗。收集了人口统计学、呼吸衰竭原因、通气设置和住院过程结果的数据。我们的终点数据为 HFPV 启动时、2 小时和 24 小时的动脉氧分压（PaO）和 PaO 与吸入氧分数（PF）比值的预 HFPV 和后 HFPV 比值。
12 例病态肥胖患者因呼吸衰竭需要 HFPV 治疗。呼吸衰竭的病因重叠，包括心源性肺水肿（n=8）、肺炎（n=5）、感染性休克（n=5）和哮喘（n=1）。在 HFPV 启动后，吸入氧分数 FiO 从 2 小时和 24 小时的 98%逐渐降至 82%和 66%。平均 PaO 从 HFPV 前的 60.9mmHg 增加到 175.1mmHg（<0.05），在 HFPV 启动时持续升高，分别为 129.5mmHg（<0.05）和 88.1mmHg（<0.005），2 小时和 24 小时。平均 PF 比值从 HFPV 前的 66.1 增加到 180.3（<0.05）、181.0（<0.05）和 148.9（<0.0005），分别在 HFPV 启动时、2 小时和 24 小时。无论患者是否返回 CMV（n=10）或仍接受 HFPV（n=2），PaO 和 PF 比值的改善在 24 小时时均是持久的。出院存活率为 66.7%。
在我们的病态肥胖患者队列中，HFPV 作为抢救治疗成功应用，避免了 ECMO 的需要。尽管我们的样本量较小，但 HFPV 应被视为病态肥胖患者在启动 ECMO 之前因 CMV 失败的抢救治疗选择。我们的回顾性分析支持将 HFPV 视为另一种治疗肥胖患者难治性低氧血症和呼吸衰竭的抢救治疗方法，这些患者在接受 CMV 治疗后未见改善。
