Hurst J M, Branson R D, DeHaven C B
J Trauma. 1987 Mar;27(3):236-42. doi: 10.1097/00005373-198703000-00002.
Post-traumatic pulmonary insufficiency or the adult respiratory distress syndrome is not infrequently associated with multiple organ-system injury. Mortality presently approaches 50%. Mechanical ventilation (CMV) with continuous positive airway pressure (CPAP) remains the mainstay of therapy. High peak inspiration (PIP) and mean airway (PAW) pressure in association with the delivery of large, conventional mechanical breaths are major determinants of complications. The efficacy of HFV was evaluated in this patient population (45 patients, mean age, 32.7 +/- 14.4 years; range, 11-75). CMV was provided with a time-cycled ventilator delivering 12-15 cc/kg tidal volume and a mechanical rate adjusted to provide a PaCO2 38-42 torr for patients previously eucapneic. CPAP was titrated to achieve a preselected endpoint of an intrapulmonary shunt of less than equal to 15%. FIO2 was maintained at or below 0.45 whenever possible. The Trauma Index Score for the group was 8.8 +/- 2.4. CMV yielded a mechanical rate of 6.3 +/- 3.2 and a CPAP of 13.9 +/- 8.5 cm H2O. High-frequency ventilation was provided by either a solenoid-based jet ventilator (HFJV) or a pneumatic cartridge high-frequency pulse generator (HFPG). Measured and calculated hemodynamic and pulmonary variables were obtained prior to and 20 minutes after transition to HFV. Thirty-three patients received HFJV; 12 patients received HFPG. Data were evaluated with a paired t-test. All patients on HFJV demonstrated improved CO2 elimination with the same hemodynamic profiles. Those on HFPG demonstrated comparable gas exchange and hemodynamic profiles with lower CPAP/PIP. Where measured, PAW was significantly lower with HFPG when compared with CMV.
创伤后肺功能不全或成人呼吸窘迫综合征常与多器官系统损伤相关。目前死亡率接近50%。持续气道正压通气（CPAP）的机械通气（CMV）仍是主要治疗方法。高峰吸气压（PIP）和平均气道压（PAW）较高，再加上输送大的传统机械通气量，是并发症的主要决定因素。在该患者群体（45例患者，平均年龄32.7±14.4岁；范围11 - 75岁）中评估了高频通气（HFV）的疗效。使用定时通气机进行CMV，输送潮气量为12 - 15 cc/kg，并调整机械通气频率以使先前呼吸正常的患者的动脉血二氧化碳分压（PaCO2）维持在38 - 42托。滴定CPAP以达到肺内分流小于或等于15%的预选终点。只要有可能，将吸入氧分数（FIO2）维持在0.45或以下。该组的创伤指数评分为8.8±2.4。CMV产生的机械通气频率为6.3±3.2，CPAP为13.9±8.5 cmH2O。通过基于电磁阀的喷射通气机（HFJV）或气动盒式高频脉冲发生器（HFPG）提供高频通气。在转换为HFV之前和之后20分钟获取测量和计算的血流动力学和肺变量。33例患者接受HFJV；12例患者接受HFPG。数据采用配对t检验进行评估。所有接受HFJV的患者在血流动力学特征相同的情况下二氧化碳清除改善。接受HFPG的患者表现出相当的气体交换和血流动力学特征，且CPAP/PIP较低。在有测量的情况下，与CMV相比，HFPG的PAW显著更低。
