High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure.
High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure.
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DOI：
10.1002/ppul.22853
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发表时间：
2014-07
影响因子：
3.1
通讯作者：
Friess, Stuart H.
中科院分区：
文献类型：
--
作者：
Yehya, Nadir;Topjian, Alexis A.;Lin, Richard;Berg, Robert A.;Thomas, Neal J.;Friess, Stuart H.
关键词：
气道压力释放通气法(APRV)和高频振荡通气法(HFOV)是治疗常规呼吸机治疗效果不佳的急性肺损伤(ALI)的常用方法。我们的目的是描述我们在难治性儿童ALI中使用APRV和HFOV的经验，并确定与生存相关的因素。我们分析了104例因常规机械通气无效而转为APRV或HFOV的低氧血症患者。在过渡到任何一种非常规机械通气(NCV)模式前和过渡后每12小时记录人口学、氧合指数(OI)和PaO2/FiO2(PF比率)。与APRV组相比，HFOV组患者年龄更小，有更明显的肺部疾病，氧合指数较高(28.5[18.6，36.2]比21.0[15.5，30.0]，P=0.008)，PF比较低(73[59，94]比99[76,131]，P=0.002)，吸入一氧化氮的频率更高。在单变量分析中，HFOV与更频繁的神经肌肉阻滞相关。104例患者中有41例(39.4%)死于NCV。幸存者在过渡到NCV后24小时显示出OI的改善，而死亡患者没有改善(12.9vs.28.1[17.6，37.1]，P<；0.001)。在控制了过渡前的免疫抑制状态、血管升压剂的数量和OI后，NCV的模式与死亡率无关。在不同类型的PICU人群中，低氧血症对常规机械通气无效，过渡到NCV，24小时内氧合的改善与生存相关。免疫功能受损状态、血管加压剂输注次数和转换为NCV前的OI与存活率独立相关。
Airway pressure release ventilation (APRV) and high frequency oscillatory ventilation (HFOV) are frequently used in acute lung injury (ALI) refractory to conventional ventilation. Our aim was to describe our experience with APRV and HFOV in refractory pediatric ALI, and to identify factors associated with survival. We analyzed 104 patients with hypoxemia refractory to conventional ventilation transitioned to either APRV or HFOV. Demographics, oxygenation index (OI), and PaO2/FiO2 (PF ratio) were recorded before transition to either mode of nonconventional ventilation (NCV) and for every 12 hr after transition. Relative to APRV, patients on HFOV were younger and had more significant lung disease evidenced by higher OI (28.5 [18.6, 36.2] vs. 21.0 [15.5, 30.0], P = 0.008), lower PF ratios (73 [59,94] vs. 99 [76,131], P = 0.002), and more frequent use of inhaled nitric oxide. In univariate analysis, HFOV was associated with more frequent neuromuscular blockade. Forty-one of 104 patients died on NCV (39.4%). Survivors demonstrated improvement in OI 24 hr after transition to NCV, whereas non-survivors did not (12.9 [8.9, 20.9] vs. 28.1 [17.6, 37.1], P < 0.001). After controlling for immunocompromised status, number of vasopressors, and OI before transition, mode of NCV was not associated with mortality. In a heterogeneous PICU population with hypoxemia refractory to conventional ventilation transitioned to NCV, improvement in oxygenation at 24 hr was associated with survival. Immunocompromised status, number of vasopressor infusions, and the OI before transition to NCV were independently associated with survival.
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影响因子：
8.8
作者：
Valentine, Stacey L.;Sapru, Anil;Randolph, Adrienne G.
通讯作者：
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DOI：
10.1164/rccm.200709-1424oc
发表时间：
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影响因子：
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影响因子：
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影响因子：
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影响因子：
158.5
作者：
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