Holzapfel L, Robert D, Perrin F, Gaussorgues P, Giudicelli D P
Intensive Care Med. 1987;13(2):100-5. doi: 10.1007/BF00254793.
Sixteen patients with acute respiratory failure (ARF) were studied. In group I (12 patients, 15 explorations) patients were treated with continuous positive pressure ventilation (CPPV) during conventional ventilation (CV), pulmonary lesions (PL) were severe (Qsp/Qt = 0.24 +/- 0.16 with PEEP = 14 +/- 7 cm H2O) and high-frequency jet ventilation (HFJV) was performed without spontaneous ventilation (SV). In group II (5 patients, 12 explorations) patients were treated with intermittent mandatory ventilation (IMV) during CV, PL were moderate (Qsp/Qt = 0.13 +/- 0.05 with PEEP = 8 +/- 3 cm H2O) and HFJV was performed with SV. In both groups, frequency was 120 c/mn and I:E ratio = 1:2. The cannula size, the driving pressure and the PEEP (water column) were progressively adapted to obtain the same blood gases as those observed during CV, FIO2 being the same. Results on HFJV were compared to CV. In both groups there were no differences between PaCO2, PaO2, FIO2, Qsp/Qt during CV and HFJV. In group I peak airway pressure (PAWP), mean artery pressure (MAP), heart rate (HR), transmural mean pulmonary and wedge pressure (MPAPtm, PWPtm) were not different. Mean airway pressure (MAWP), PEEP and pleural pressure (PP) were higher, cardiac index (CI) was lower. In group II, PP, CI, MAP, HR, MPAPtm, MPWPtm were not different. PAWP was lower, MAWP and PEEP were higher. We conclude that during HFJV it is possible to obtain the same blood gas as during CV, but HFJV without CV may not be indicated in patients with severe PL, because circulatory impairment is higher.
对16例急性呼吸衰竭（ARF）患者进行了研究。在第一组（12例患者，15次探查）中，患者在传统通气（CV）期间接受持续正压通气（CPPV）治疗，肺部病变（PL）严重（在呼气末正压通气（PEEP）为14±7 cmH₂O时，分流率/心输出量（Qsp/Qt）=0.24±0.16），并在无自主通气（SV）的情况下进行高频喷射通气（HFJV）。在第二组（5例患者，12次探查）中，患者在CV期间接受间歇强制通气（IMV）治疗，PL为中度（在PEEP为8±3 cmH₂O时，Qsp/Qt =0.13±0.05），并在有SV的情况下进行HFJV。在两组中，频率均为120次/分钟，吸呼比=1:2。逐步调整套管尺寸、驱动压力和PEEP（水柱），以获得与CV期间观察到的相同的血气，吸入氧分数（FIO₂）相同。将HFJV的结果与CV进行比较。在两组中，CV和HFJV期间的动脉血二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）、FIO₂、Qsp/Qt之间均无差异。在第一组中，气道峰值压力（PAWP）、平均动脉压（MAP）、心率（HR）、跨壁平均肺动脉压和楔压（MPAPtm、PWPtm）无差异。平均气道压（MAWP）、PEEP和胸膜压力（PP）较高，心脏指数（CI）较低。在第二组中，PP、CI、MAP、HR、MPAPtm、MPWPtm无差异。PAWP较低，MAWP和PEEP较高。我们得出结论，在HFJV期间可以获得与CV期间相同的血气，但对于PL严重的患者，可能不建议在没有CV的情况下进行HFJV，因为循环系统损害更高。
