Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome
Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome
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DOI：
10.1097/00003246-199601000-00006
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发表时间：
1996-01-01
影响因子：
8.8
通讯作者：
Hirschl, RB
中科院分区：
文献类型：
--
作者：
Gauger, PG;Pranikoff, T;Hirschl, RB
目的：此前尚未报道过使用全氟化碳液体通气治疗新生儿期以上呼吸衰竭的儿科患者。我们评估了 6 名患有急性呼吸窘迫综合征且严重需要体外生命支持 (ECLS) 的儿科患者的部分液体通气技术。设计：本研究是一项非对照、I/II 期实验研究，采用单组前测/后测设计。背景：所有研究均在密歇根大学医学院的三级儿科转诊医院进行。患者：6 名儿科患者，年龄从 8 周到 5 1/2 岁，患有严重呼吸衰竭，需要进行体外生命支持。 ECLS 支持气体交换。干预措施：ECLS 2 至 9 天后，将全氟化碳注入气管，直至每个肺的依赖区被充满。初始给药剂量为 12.9 +/- 2.3 mL/kg（范围 5 至 20）。然后对全氟化碳填充的肺进行气体通气（部分液体通气）。每天重复全氟化碳剂量，总共 3 至 7 天，累积剂量为 45.2 +/- 6.1 mL/kg（范围 30 至 72.5）。 测量和主要结果：所有自然气体交换测量均在 ECLS 中断的短暂期间进行，包括 PaO2 和肺泡动脉氧梯度 P(A-a)O-2。还直接测量了根据体重校正的静态肺顺应性。初始剂量后 96 小时内，平均 PaO2 从 39 +/- 6 增加到 92 +/- 29 托（5.2 +/- 0.8 到 12.2 +/- 3.9 kPa）（通过重复测量方差分析，p = .021）。同一时间段内，平均 P(A-a)O-2 从 635 +/- 10 下降到 499 +/- 77 托（84.7 +/- 1.3 到 66.5 +/- 10.3 kPa）（p = .059），而平均静态肺顺应性（根据患者体重标准化）从 0.12 +/- 0.02 增加到 0.28 +/- 0.08毫升/厘米水柱/千克 (p = .01)。六名患者全部幸存。与部分液体通气潜在相关的并发症仅限于六名患者中的两名出现气胸。结论：全氟化碳可以安全地注入 ECLS 中严重呼吸衰竭的儿科患者的肺部，并且可能与气体交换和肺顺应性的改善有关。
Objective: Liquid ventilation with perfluorocarbon previously has not been reported in pediatric patients with respiratory failure beyond the neonatal period. We evaluated the technique of partial liquid ventilation in six pediatric patients with the acute respiratory distress syndrome of sufficient severity to require extracorporeal life support (ECLS).Design: This study was a noncontrolled, phase I/II experimental study with a single group pretest/posttest design.Setting: All studies were performed at a tertiary, pediatric referral hospital at the University of Michigan Medical School.Patients: Six pediatric patients, from 8 wks to 5 1/2 yrs of age, with severe respiratory failure requiring ECLS to support gas exchange.Interventions: After 2 to 9 days on ECLS, perfluorocarbon was administered into the trachea until the dependent zone of each lung was filled. The initial dose administered was 12.9 +/- 2.3 mL/kg (range 5 to 20). Gas ventilation of the perfluorocarbon filled lungs (partial liquid ventilation) was then performed. The perfluorocarbon dose was repeated daily for a total of 3 to 7 days, with a cumulative dose of 45.2 +/- 6.1 mL/kg (range 30 to 72.5).Measurements and Main Results: All measurements of native gas exchange were made during brief periods of discontinuation of ECLS and include PaO2 and the alveolar-arterial oxygen gradient, P(A-a)O-2. Static pulmonary compliance, corrected for weight, was also measured directly.The mean PaO2 increased from 39 +/- 6 to 92 +/- 29 torr (5.2 +/- 0.8 to 12.2 +/- 3.9 kPa) over the 96 hrs after the initial dose (p = .021 by repeated-measures analysis of variance). The average P(A-a)O-2 decreased from 635 +/- 10 to 499 +/- 77 torr (84.7 +/- 1.3 to 66.5 +/- 10.3 kPa) over the same time period (p = .059), while the mean static pulmonary compliance (normalized for patient weight) increased from 0.12 +/- 0.02 to 0.28 +/- 0.08 mL/cm H2O/kg (p = .01). All six patients survived. Complications potentially associated with partial liquid ventilation were limited to pneumothoraces in two of six patients.Conclusions: Perfluorocarbon may be safely administered into the lungs of pediatric patients with severe respiratory failure on ECLS and may be associated with improvement in gas exchange and pulmonary compliance.