High-Frequency Oscillation for Acute Respiratory Distress Syndrome
High-Frequency Oscillation for Acute Respiratory Distress Syndrome
复制标题
DOI：
10.1056/nejmoa1215716
复制
发表时间：
2013-02-28
影响因子：
158.5
通讯作者：
Cuthbertson, Brian H.
中科院分区：
文献类型：
--
作者：
Young, Duncan;Lamb, Sarah E.;Cuthbertson, Brian H.
急性呼吸窘迫综合征（ARDS）患者需要机械通气来维持动脉氧合，但这种治疗可能会产生继发性肺损伤。高频振荡通气（HFOV）可能会减少这种继发性damage. METHODS在一项多中心研究中，我们随机分配成人需要机械通气的ARDS进行HFOV与Novalung R100呼吸机（Metran）或通常的辅助护理。所有患者的动脉血氧分压（Pao（2））与吸入氧分数（F-IO 2）的比值均≤ 200 mmHg（26.7 kPa），预期通气持续时间至少为2天。主要结局是随机分组后30天的全因死亡率。结果：HFOV组398例患者中有166例（41.7%）发生主要结局，而常规通气组397例患者中有163例（41.1%）发生主要结局，两组间无显著差异（卡方检验P = 0.85）。调整研究中心、性别、急性生理学和慢性健康状况评估（APACHE）II评分和初始Pao 2：F-IO 2比值后，常规通气组的生存优势比为1.03（95%置信区间为0.75 - 1.40; Logistic回归P = 0.87）。（由国家卫生研究所卫生技术评估计划资助; OSCAR当前对照试验编号，ISRCTN 10416500。
BACKGROUNDPatients with the acute respiratory distress syndrome (ARDS) require mechanical ventilation to maintain arterial oxygenation, but this treatment may produce secondary lung injury. High-frequency oscillatory ventilation (HFOV) may reduce this secondary damage.METHODSIn a multicenter study, we randomly assigned adults requiring mechanical ventilation for ARDS to undergo either HFOV with a Novalung R100 ventilator (Metran) or usual ventilatory care. All the patients had a ratio of the partial pressure of arterial oxygen (Pao(2)) to the fraction of inspired oxygen (F-IO2) of 200 mm Hg (26.7 kPa) or less and an expected duration of ventilation of at least 2 days. The primary outcome was all-cause mortality 30 days after randomization.RESULTSThere was no significant between-group difference in the primary outcome, which occurred in 166 of 398 patients (41.7%) in the HFOV group and 163 of 397 patients (41.1%) in the conventional-ventilation group (P = 0.85 by the chi-square test). After adjustment for study center, sex, score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and the initial Pao2:F-IO2 ratio, the odds ratio for survival in the conventional-ventilation group was 1.03 (95% confidence interval, 0.75 to 1.40; P = 0.87 by logistic regression).CONCLUSIONSThe use of HFOV had no significant effect on 30-day mortality in patients undergoing mechanical ventilation for ARDS. (Funded by the National Institute for Health Research Health Technology Assessment Programme; OSCAR Current Controlled Trials number, ISRCTN10416500.)