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新生儿转运期间采用或不采用容量保证的高频振荡通气。

High-frequency oscillatory ventilation with or without volume guarantee during neonatal transport.

作者信息

Balog Vera, Liszkay Gabor, Lantos Lajos, Jermendy Agnes, Belteki Gusztav

机构信息

Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary.

Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary.

出版信息

J Perinatol. 2025 Jan;45(1):43-49. doi: 10.1038/s41372-024-02109-9. Epub 2024 Sep 6.

DOI:10.1038/s41372-024-02109-9
PMID:39242946
Abstract

OBJECTIVES

To analyse deviation of ventilator parameters from their set targets during high-frequency oscillatory ventilation (HFOV) with or without volume guarantee (VG) and compare the two modes during emergency neonatal transport.

STUDY DESIGN

Retrospective observational study using the fabian™ HFOi ventilator.

RESULTS

Median deviation of mean airway pressure from the set value was <1 cmHO. During HFOV the pressure amplitude differed from the set value by <1 cmHO. During HFOV-VG median deviation of the oscillation volume (VThf) from the targeted value was -0.07 mL/kg, but in some cases VThf was by >0.38 mL/kg below target. Setting maximum allowed amplitude 10 cmHO above the usually required amplitude improved maintenance of VThf. HFOV and HFOV-VG parameters were similar, except the lower amplitude during HFOV without VG. VThf <2.5 mL/kg avoided hypercapnia in most cases.

CONCLUSIONS

HFOV and HFOV-VG maintain ventilator parameters close to their targets and are promising modalities during neonatal transport.

摘要

目的

分析在有或没有容量保证(VG)的高频振荡通气(HFOV)期间呼吸机参数与其设定目标的偏差,并在新生儿紧急转运期间比较这两种模式。

研究设计

使用fabian™ HFOi呼吸机进行回顾性观察研究。

结果

平均气道压与设定值的中位数偏差<1 cmH₂O。在HFOV期间,压力振幅与设定值的差异<1 cmH₂O。在HFOV-VG期间,振荡容积(VThf)与目标值的中位数偏差为-0.07 mL/kg,但在某些情况下,VThf比目标值低>0.38 mL/kg。将最大允许振幅设置为比通常所需振幅高10 cmH₂O可改善VThf的维持。HFOV和HFOV-VG参数相似,但无VG的HFOV期间振幅较低。在大多数情况下,VThf<2.5 mL/kg可避免高碳酸血症。

结论

HFOV和HFOV-VG可使呼吸机参数维持在接近目标值的水平,是新生儿转运期间有前景的通气模式。

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本文引用的文献

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Oscillometry for personalizing continuous distending pressure maneuvers: an observational study in extremely preterm infants.振袖测量法用于连续扩张压力操作的个体化:极低出生体重儿的观察性研究。
Respir Res. 2024 Jan 4;25(1):4. doi: 10.1186/s12931-023-02639-4.
2
Understanding improved neonatal ventilation trends in a regional transport service.理解区域性转运服务中新生儿通气改善的趋势。
Acta Paediatr. 2024 Apr;113(4):709-715. doi: 10.1111/apa.17065. Epub 2023 Dec 29.
3
Lung protection strategy with high-frequency oscillatory ventilation improves respiratory outcomes at two years in preterm respiratory distress syndrome: a before and after, quality improvement study.
高频振荡通气肺保护策略改善早产呼吸窘迫综合征患儿两年时的呼吸结局:一项前后对照的质量改进研究
J Matern Fetal Neonatal Med. 2022 Dec;35(26):10698-10705. doi: 10.1080/14767058.2022.2155040. Epub 2022 Dec 15.
4
Acceleration during neonatal transport and its impact on mechanical ventilation.新生儿转运中的加速及其对机械通气的影响。
Arch Dis Child Fetal Neonatal Ed. 2023 Jan;108(1):38-44. doi: 10.1136/archdischild-2021-323498. Epub 2022 Jun 15.
5
Safety use of high frequency oscillatory ventilation in transport of newborn infants affected by severe respiratory failure: preliminary data in central Tuscany.高频振荡通气在转运严重呼吸衰竭新生儿中的安全应用:托斯卡纳中部的初步数据。
BMC Pediatr. 2022 Jun 10;22(1):335. doi: 10.1186/s12887-022-03393-0.
6
Effects of High-Frequency Oscillatory Ventilation With Volume Guarantee During Surfactant Treatment in Extremely Low Gestational Age Newborns With Respiratory Distress Syndrome: An Observational Study.肺表面活性物质治疗期间容量保证的高频振荡通气对极早早产儿呼吸窘迫综合征的影响:一项观察性研究
Front Pediatr. 2022 Mar 3;9:804807. doi: 10.3389/fped.2021.804807. eCollection 2021.
7
High-frequency ventilation in preterm infants and neonates.高频通气在早产儿和新生儿中的应用。
Pediatr Res. 2023 Jun;93(7):1810-1818. doi: 10.1038/s41390-021-01639-8. Epub 2022 Feb 8.
8
Volume-Targeted Ventilation.容量目标通气。
Clin Perinatol. 2021 Dec;48(4):825-841. doi: 10.1016/j.clp.2021.08.001.
9
Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO Levels for Optimal Ventilation Using Open-Lung Strategies.肺容量保证在患有呼吸窘迫综合征的早产儿中的高频振荡通气:采用肺开放策略实现最佳通气的潮气量和二氧化碳清除水平
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Pediatr Crit Care Med. 2019 Dec;20(12):1170-1176. doi: 10.1097/PCC.0000000000002090.