Bishop M J, Benson M S, Sato P, Pierson D J
Anesth Analg. 1987 Sep;66(9):833-8.
In seven patients with acute respiratory failure and a bronchopleural fistula, the authors compared gas exchange and volume of gas lost via the chest tube during conventional mechanical ventilation (CV) and high-frequency jet ventilation (HFJV). After the initial comparison, patients were randomized to HFJV or CV, unless one mode of ventilation was clearly superior based on preestablished criteria. In six of the seven patients, oxygenation deteriorated after the switch from CV to HFJV. The ratio of PaCO2 to FI02 declined from 227 +/- 167 to 133 +/- 100 (mean +/- SD, P less than 0.05), and the PaCO2 increased from 47 +/- 13 to 56 +/- 18 mm Hg (P less than 0.05). The mean chest tube leak did not change significantly. Randomization of the mode of ventilation was not performed in any patient because CV was superior by a priori criteria. We conclude that when acute respiratory failure is complicated by a bronchopleural fistula, HFJV with mean airway pressures comparable to those provided during conventional ventilation does not provide satisfactory gas exchange.
在7例急性呼吸衰竭合并支气管胸膜瘘的患者中，作者比较了传统机械通气（CV）和高频喷射通气（HFJV）期间的气体交换情况以及经胸管丢失的气体量。在初始比较后，除非根据既定标准某一种通气模式明显更优，否则患者被随机分配至HFJV或CV组。7例患者中有6例在从CV转换为HFJV后氧合恶化。动脉血二氧化碳分压（PaCO2）与吸入氧分数（FI02）的比值从227±167降至133±100（均值±标准差，P<0.05），且PaCO2从47±13升高至56±18 mmHg（P<0.05）。胸管漏气的平均值无显著变化。由于根据先验标准CV更优，因此没有对任何患者进行通气模式的随机分配。我们得出结论，当急性呼吸衰竭合并支气管胸膜瘘时，平均气道压力与传统通气相当的HFJV不能提供令人满意的气体交换。
