Gerstmann D R, deLemos R A, Coalson J J, Clark R H, Wiswell T E, Winter D C, Kuehl T J, Meredith K S, Null D M
Department of Pediatrics, Wilford Hall USAF Medical Center, San Antonio, Texas.
Pediatr Pulmonol. 1988;5(2):82-91. doi: 10.1002/ppul.1950050204.
To assess the influence of ventilatory technique on pulmonary baroinjury in experimental hyaline membrane disease, we randomized 24 premature baboons to six treatment groups according to ventilator (PPV, positive pressure ventilator; HFO, high frequency oscillator; HFI, high frequency flow interrupter) and O2 therapy FIO2 as clinically indicated, or FIO2 1.0). PaCO2 was adjusted by varying pressure amplitude, and for PPV, also by rate (less than 60/min). HFO and HFI were set at a frequency of 10 Hz. Animals were cared for with standard NICU techniques until death or sacrifice at 11 days. One animal died at delivery and was excluded from data analysis. There were no intergroup differences in Paw, Pa/AO2, PaCO2 or oxygenation index (IO2 = [Pa/AO2]/Paw) prior to death of the first study animal at 13 h. Animals who subsequently developed airleak had higher Paw, lower Pa/AO2 and lower IO2 during this period. The degree of airleak was significantly less with HFO compared to PPV or HFI. The effect of O2 exposure did not appear different with respect to the degree of airleak or the frequency of severe tracheal injury, although survival was shortened. Severe tracheal injury was more frequent with HFI compared to PPV or HFO. BPD was found only in 100% O2 exposed animals surviving greater than 1 wk. Management of premature baboons with HFO and appropriate O2 resulted in less severe airleak, 100% survival, and no evidence of severe tracheal injury or BPD. These outcomes were not achieved with clinically similar strategies using PPV or HFI.
为评估通气技术对实验性透明膜病肺气压伤的影响，我们根据呼吸机类型（PPV，正压通气机；HFO，高频振荡通气机；HFI，高频气流阻断通气机）以及临床指征的O₂治疗FIO₂（或FIO₂ 1.0），将24只早产狒狒随机分为六个治疗组。通过改变压力幅度来调整PaCO₂，对于PPV，也通过频率（小于60次/分钟）进行调整。HFO和HFI设置为10赫兹的频率。采用标准新生儿重症监护室技术照料动物，直至11天时死亡或处死后取材。1只动物在分娩时死亡，被排除在数据分析之外。在首只研究动物于13小时死亡前，各治疗组之间在气道峰压（Paw）、氧合指数（Pa/AO₂）、PaCO₂或氧合指数（IO₂ = [Pa/AO₂]/Paw）方面并无差异。随后发生气漏的动物在此期间具有更高的Paw、更低的Pa/AO₂和更低的IO₂。与PPV或HFI相比，HFO导致的气漏程度显著更低。尽管存活时间缩短，但在气漏程度或严重气管损伤频率方面，O₂暴露的影响似乎并无差异。与PPV或HFO相比，HFI导致的严重气管损伤更为频繁。仅在存活超过1周的100% O₂暴露动物中发现支气管肺发育不良（BPD）。采用HFO和适当的O₂对早产狒狒进行管理，可减少严重气漏的发生，实现100%存活，且无严重气管损伤或BPD的证据。使用PPV或HFI的临床类似策略未取得这些结果。
