Lung volume and the response to high volume strategy, high frequency oscillation
Lung volume and the response to high volume strategy, high frequency oscillation
复制标题
肺容量和对高容量策略、高频振荡的反应
作者：
G. Dimitriou;Paul Cheeseman;A. Greenough
背景：患有严重呼吸衰竭的婴儿经常被转移到高容量策略，高频振荡（HFO）。然后平均气道压（MAP）升高，目的是打开肺不张的肺，从而改善气体交换。目的：检验转移前肺容量可预测对高容量策略HFO的反应的假设，并确定与不良结局（死亡）相关的因素。研究方法：通过测量功能残气量（FRC）评估肺容量，并通过从常规机械通气（CMV）转移到高容量策略HFO的最佳MAP时肺泡动脉压差（AaDO 2）的变化确定对HFO的反应。患者：研究了42例中位胎龄为28周（范围23 - 40周）的婴儿。结果如下：转移前的FRC与优化氧合所需的MAP变化显著相关（p= 0.012），但与HFO引起的AaDO 2变化无关。存活者和非存活者的肺体积无显著差异，但死亡者更不成熟（p= 0.0009），对HFO的反应较小（p= 0.035）。
Background: Infants with severe respiratory failure are frequently transferred to high volume strategy, high frequency oscillation (HFO). Mean airway pressure (MAP) is then elevated, the aim being to open up atelectatic lungs and hence improve gas exchange. Aim: To test the hypothesis that lung volume prior to transfer would predict the response to high volume strategy HFO and identify which factors related to poor outcome (death). Methods: Lung volume was assessed by measurement of functional residual capacity (FRC) and the response to HFO determined by the change in the alveolar arterial gradient (AaDO2) on transfer from conventional mechanical ventilation (CMV) to the optimal MAP on high volume strategy HFO. Patients: Forty‐two infants with a median gestational age of 28 (range 23 to 40) wk were studied. Results: FRC prior to transfer correlated significantly with the change in MAP necessary to optimize oxygenation (p= 0.012), but not the change in AaDO2 in response to HFO. There were no significant differences in the lung volumes of survivors and non‐survivors, but those who died were more immature (p= 0.0009) and had a smaller response to HFO (p= 0.035).