Oribabor Charles, Gulkarov Iosif, Khusid Felix, Ms Emma Fischer, Esan Adebayo, Rizzuto Nancy, Tortolani Anthony, Dattilo Paris Ayanna, Suen Kaki, Ugwu Justin, Kenney Brent
Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Department of Cardiothoracic Surgery, Staten Island University Hospital Staten Island, NY, USA.
Can J Respir Ther. 2018 Fall;54(3):58-61. doi: 10.29390/cjrt-2018-013. Epub 2018 Nov 1.
Respiratory failure represents a significant source of morbidity and mortality for surgical patients. High-frequency percussive ventilation (HFPV) is emerging as a potentially effective rescue therapy in patients failing conventional mechanical ventilation (CMV). Use of HFPV is often limited by concerns for potential effects on hemodynamics, which is particularly tenuous in patients immediately after cardiac surgery. In this manuscript we evaluated the effects of HFPV on gas exchange and cardiac hemodynamics in the immediate postoperative period after cardiac surgery, in comparison with CMV.
Twenty-four consecutive cardiac surgery patients were ventilated in immediate postoperative period with HFPV for two to four hours, then they switched to a CMV using the adaptive support ventilation mode for weaning. Arterial blood gases were performed during the first and second hour on HFPV, and at 45 minutes after initiation of CMV. Respiratory settings and invasive hemodynamic data (mixed venous oxygen saturation, central venous pressure, systemic and pulmonary blood pressure, cardiac output and index) were collected utilizing right heart pulmonary catheter and arterial lines during HFPV and CMV. Primary outcome was improvement in the ratio between partial pressure of oxygen to fraction of inspired oxygen (P/F ratio) and changes in hemodynamics.
Analysis of data for 24 patients revealed a significantly better P/F ratio during the first and second hour on HFPV, compared with a P/F ratio on CMV (420.0 ± 158.8, 459.2 ± 138.5, and 260.2 ± 98.5 respectively, < 0.05), suggesting much better gas exchange on HFPV than on CMV. Hemodynamics were not affected by the mode of the ventilation.
Improvement in gas exchange, reflected in a significantly improved P/F ratio, wasn't accompanied by worsening in hemodynamic parameters. The significant gains in the P/F ratio were lost when patients were switched to conventional ventilation. This data suggest that HFPV provides significantly better gas exchange compared with CMV and can be safely utilized in postoperative cardiac patients without any significant effect on hemodynamics.
呼吸衰竭是外科患者发病和死亡的重要原因。高频振荡通气（HFPV）正逐渐成为常规机械通气（CMV）失败患者的一种潜在有效抢救治疗方法。HFPV的使用常常受到对其对血流动力学潜在影响的担忧的限制，这在心脏手术后即刻的患者中尤为明显。在本手稿中，我们评估了HFPV与CMV相比，对心脏手术后即刻术后阶段气体交换和心脏血流动力学的影响。
连续24例心脏手术患者在术后即刻接受HFPV通气两至四小时，然后切换至采用适应性支持通气模式进行撤机的CMV。在HFPV的第一小时和第二小时以及CMV启动后45分钟进行动脉血气分析。在HFPV和CMV期间，利用右心漂浮导管和动脉导管收集呼吸参数设置和有创血流动力学数据（混合静脉血氧饱和度、中心静脉压、体循环和肺循环血压、心输出量和心指数）。主要结局是氧分压与吸入氧分数之比（P/F比）的改善和血流动力学的变化。
对24例患者的数据分析显示，与CMV时的P/F比相比，HFPV第一小时和第二小时的P/F比显著更好（分别为420.0±158.8、459.2±138.5和260.2±98.5，P<0.05），表明HFPV时的气体交换比CMV时好得多。血流动力学不受通气模式的影响。
气体交换的改善表现为P/F比显著提高，且未伴有血流动力学参数恶化。当患者切换至常规通气时，P/F比的显著改善消失。该数据表明，与CMV相比，HFPV可提供显著更好的气体交换，并且可安全用于术后心脏患者，而对血流动力学无任何显著影响。
