Zhang Jin, Qu Dong, Ren Xiaoxu, Liu Guyue, Wu Yahui
Department of Critical Medicine, Children's Hospital Affiliated to the Capital Institute of Pediatrics, Beijing 100020, China. Corresponding author: Qu Dong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Apr;33(4):455-459. doi: 10.3760/cma.j.cn121430-20201106-00706.
To compare the clinical efficacy of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) in the treatment of infants with severe respiratory syncytial virus (RSV) pneumonia.
A prospective randomized controlled trial was conducted. The infants with severe RSV pneumonia who received invasive mechanical ventilation admitted to intensive care unit (ICU) of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2018 to December 2019 were enrolled. According to the order of admission, each infant was assigned to HFOV group or CMV group by random number table. The basic data, pediatric critical score, blood gas analysis, ventilator parameters, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO)/arterial partial pressure of oxygen (PaO)×100], duration of mechanical ventilation, length of ICU stay, complications, prognosis, use of muscle relaxants and vasoactive drugs and other clinical indicators of the two groups were recorded.
A total of 28 infants were enrolled in the analysis, including 15 infants receiving CMV and 13 infants receiving HFOV. There were no significant differences in age, body weight, pediatric critical score and OI before enrollment, type II respiratory failure, multiple organ dysfunction, basic diseases and laboratory examination indexes before enrollment between the two groups. Six hours after enrollment, compared with CMV group, heart rate (HR), respiratory rate (RR), case of transcutaneous oxygen saturation (SpO) decrease, case of HR decrease, case of cardiopulmonary resuscitation (CPR) and OI in HFOV group were significantly decreased [HR (bpm): 130 (125, 138) vs. 144 (140, 160), RR (times/min): 35 (34, 38) vs. 40 (35, 45), SpO decrease (case: 1 vs. 10), HR decrease (case: 0 vs. 6), CPR (case: 0 vs. 4), OI: 6.5 (4.4, 8.9) vs. 9.3 (8.0, 12.8)], while case of use of muscle relaxants (case: 3 vs. 0) and volume of 7-day positive fluid balance [mL/kg: 167.1 (113.8, 212.6) vs. 90.8 (57.8, 112.7)] were significantly higher, the differences were statistically significant (all P < 0.05). There was no use of blood purification treatment, no severe complications such as pneumothorax and intracranial hemorrhage, and no death within 28 days in the two groups.
Compared with CMV, HFOV in the treatment of infants with severe RSV pneumonia can improve the oxygenation level and clinical physiological indexes earlier, reduce the incidence of adverse events such as HR, SpO decrease and CPR, increase the use of muscle relaxants and the positive fluid balance, and do not increase the incidence of severe complications such as pneumothorax and intracranial hemorrhage, so its clinical application is safe.
比较高频振荡通气（HFOV）与传统机械通气（CMV）治疗重症呼吸道合胞病毒（RSV）肺炎患儿的临床疗效。
进行一项前瞻性随机对照试验。选取2018年1月至2019年12月在北京儿童医院重症医学科接受有创机械通气的重症RSV肺炎患儿。按照入院顺序，采用随机数字表法将患儿分为HFOV组和CMV组。记录两组患儿的基本资料、小儿危重评分、血气分析、呼吸机参数、氧合指数[OI，OI = 平均气道压（Pmean）×吸入氧分数（FiO）/动脉血氧分压（PaO）×100]、机械通气时间、重症监护病房（ICU）住院时间、并发症、预后、肌肉松弛剂及血管活性药物使用情况等临床指标。
共纳入28例患儿进行分析，其中CMV组15例，HFOV组13例。两组患儿入组前年龄、体重、小儿危重评分及OI、Ⅱ型呼吸衰竭、多器官功能障碍、基础疾病及实验室检查指标比较，差异均无统计学意义。入组后6小时，与CMV组比较，HFOV组心率（HR）、呼吸频率（RR）、经皮血氧饱和度（SpO）下降例数、HR下降例数、心肺复苏（CPR）例数及OI均明显降低[HR（次/分）：130（125，138）比144（140，160），RR（次/分）：35（34，38）比40（35，45），SpO下降（例）：1比10，HR下降（例）：0比6，CPR（例）：0比4，OI：6.5（4.4，8.9）比9.3（8.0，12.8）]，而肌肉松弛剂使用例数（例：3比0）及7天正性液体平衡量[mL/kg：167.1（113.8，212.6）比90.8（57.8，112.7）]明显增多，差异均有统计学意义（均P < 0.05）。两组均未行血液净化治疗，均未发生气胸、颅内出血等严重并发症，28天内均无死亡。
与CMV相比，HFOV治疗重症RSV肺炎患儿可更早改善氧合水平及临床生理指标、降低HR、SpO下降及CPR等不良事件发生率，增加肌肉松弛剂使用及正性液体平衡量，且不增加气胸、颅内出血等严重并发症发生率，临床应用安全。
