Department of Cardiac Surgery, Pavlov First St. Petersburg Medical University, St. Petersburg, Russian Federation.
Department of Anaesthesia and Intensive Care Medicine III, Fundeni Clinical Institute, Bucharest, Romania.
Am J Case Rep. 2021 Feb 5;22:e928421. doi: 10.12659/AJCR.928421.
BACKGROUND High-frequency percussive ventilation (HFPV) is a method that combines mechanical ventilation with high-frequency oscillatory ventilation. This report describes 3 cases of patients with severe COVID-19 pneumonia who received intermittent adjunctive treatment with HFPV at a single center without requiring admission to the Intensive Care Unit (ICU). CASE REPORT Case 1 was a 60-year-old woman admitted to the hospital 14 days after the onset of SARS-CoV-2 infection symptoms, and cases 2 and 3 were men aged 65 and 72 years who were admitted to the hospital 10 days after the onset of SARS-CoV-2 infection symptoms. All 3 patients presented with clinical deterioration accompanied by worsening lung lesions on computed tomography (CT) scans after 21 days from the onset of symptoms. SARS-CoV-2 infection was confirmed in all patients by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay from nasal swabs. All 3 patients had impending respiratory failure when non-invasive intermittent HFPV therapy was initiated. After therapy, the patients had significant clinical improvement and visibly decreased lung lesions on followup CT scans performed 4-6 days later. CONCLUSIONS The 3 cases described in this report showed that the use of intermittent adjunctive treatment with HFPV in patients with severe pneumonia due to infection with SARS-CoV-2 improved lung function and may have prevented clinical deterioration. However, recommendations on the use of intermittent HFPV as an adjunctive treatment in COVID-19 pneumonia requires large-scale controlled clinical studies. In the pandemic context, with a shortage of ICU beds, avoiding ICU admission by using adjunctive therapies on the ward is a useful option.
高频脉冲通气（HFPV）是一种将机械通气与高频振荡通气相结合的方法。本报告描述了在一家中心医院，3 例重症 COVID-19 肺炎患者在无需入住重症监护病房（ICU）的情况下，间断给予 HFPV 辅助治疗的情况。
病例 1 为一名 60 岁女性，在出现 SARS-CoV-2 感染症状后 14 天入院，病例 2 和 3 为 65 岁和 72 岁男性，在出现 SARS-CoV-2 感染症状后 10 天入院。所有 3 例患者在症状出现后 21 天，均出现临床恶化，同时 CT 扫描显示肺部病变加重。所有患者的鼻拭子实时逆转录聚合酶链反应（RT-PCR）检测均证实 SARS-CoV-2 感染。所有 3 例患者在开始无创间断 HFPV 治疗时均有即将发生呼吸衰竭的情况。治疗后，患者的临床状况显著改善，4-6 天后复查 CT 扫描，肺部病变明显减少。
本报告描述的 3 例病例表明，对于由 SARS-CoV-2 感染引起的重症肺炎患者，间断给予 HFPV 辅助治疗可改善肺功能，并可能防止病情恶化。然而，对于 COVID-19 肺炎患者间断使用 HFPV 作为辅助治疗的建议，需要大规模的对照临床研究。在大流行背景下，由于 ICU 床位短缺，在病房中使用辅助治疗来避免 ICU 入院是一种有用的选择。
