Gaylord M S, Quissell B J, Lair M E
Pediatrics. 1987 Jun;79(6):915-21.
Pulmonary interstitial emphysema is one of the most serious complications of the respiratory distress syndrome. Its presence significantly increases morbidity and mortality. Preliminary reports have demonstrated the success of high-frequency ventilation in the treatment of pulmonary interstitial emphysema. In a previous investigation, we were able to develop a formula for predicting death in infants weighing less than 1,500 g with pulmonary interstitial emphysema. Using this subgroup of severely affected infants, we studied the efficacy of high-frequency ventilation in nine infants. Using the Volumetric Diffusive Respirator, we observed improvement in all respiratory values measured (pH, PCO2, and PO2), a significantly decreased mean airway pressure (MAP), and improvement in neonatal mortality. Complications of severe bleeding diatheses, hypotension, bronchopulmonary dysplasia, and necrotizing tracheobronchitis were observed. Our investigation was the first to systematically choose infants who might benefit from high-frequency ventilation and to compare them with similar infants with known outcomes. We realize that the study was rescue in nature using historical controls, but we felt compelled to assure the safety of the device before randomizing less sick infants. High-frequency ventilation appears to be effective in the acute management of low birth weight infants with pulmonary interstitial emphysema.
肺间质气肿是呼吸窘迫综合征最严重的并发症之一。它的出现显著增加了发病率和死亡率。初步报告已证明高频通气治疗肺间质气肿取得成功。在之前的一项研究中，我们能够制定出一个公式来预测体重低于1500克的患有肺间质气肿的婴儿的死亡情况。利用这一严重受影响婴儿的亚组，我们研究了高频通气对9名婴儿的疗效。使用容积扩散呼吸器，我们观察到所有测量的呼吸值（pH值、二氧化碳分压和氧分压）均有改善，平均气道压（MAP）显著降低，新生儿死亡率也有所改善。观察到有严重出血倾向、低血压、支气管肺发育不良和坏死性气管支气管炎等并发症。我们的研究首次系统地选择了可能从高频通气中受益的婴儿，并将他们与已知预后的类似婴儿进行比较。我们意识到该研究本质上是采用历史对照的救援性研究，但我们觉得在将病情较轻的婴儿随机分组之前，必须确保该设备的安全性。高频通气似乎对患有肺间质气肿的低体重婴儿的急性治疗有效。
