Effect of high-frequency oscillatory ventilation on esophageal and transpulmonary pressures in moderate-to-severe acute respiratory distress syndrome
Effect of high-frequency oscillatory ventilation on esophageal and transpulmonary pressures in moderate-to-severe acute respiratory distress syndrome
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DOI：
10.1186/s13613-016-0181-1
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发表时间：
2016-08-30
影响因子：
8.1
通讯作者：
Papazian, Laurent
中科院分区：
文献类型：
--
作者：
Guervilly, Christophe;Forel, Jean-Marie;Papazian, Laurent
背景资料：高频振荡通气（HFOV）在中重度急性呼吸窘迫综合征（ARDS）的治疗中尚未显示出益处。HFOV期间施加到肺部的实际压力存在不确定性。因此，我们进行了一项研究，以比较在常规机械通气（CMV）和不同水平的平均气道压（mPaw）在HFOV。方法：这是一项前瞻性随机交叉研究，在一所大学教学医院。使用食管球囊导管测量吸气末和呼气末的食管压力（Pes）并计算P-L。在使用CMV（CMVpre）通气期间进行测量，之后将患者转换为HFOV，并将3个1小时不同水平的mPaw设置为高于CMV期间测量的平均气道压+5、+10和+15 cm H2O。结果：10例中重度ARDS患者纳入研究。我们证明了在HFOV期间Pes和P-L随着mPaw的增加而线性增加。与CMV相反，P-L在HFOV期间始终为阳性，无论应用的mPaw水平如何，但与氧合改善无关。我们发现mPaw和Pes.Conclusion之间的显着相关性：HFOV与高水平的mPaw增加经肺动脉压，而不改善氧合。
Background: High-frequency oscillatory ventilation (HFOV) has not been shown to be beneficial in the management of moderate-to-severe acute respiratory distress syndrome (ARDS). There is uncertainty about the actual pressure applied into the lung during HFOV. We therefore performed a study to compare the transpulmonary pressure (PL) during conventional mechanical ventilation (CMV) and different levels of mean airway pressure (mPaw) during HFOV.Methods: This is a prospective randomized crossover study in a university teaching hospital. An esophageal balloon catheter was used to measure esophageal pressures (Pes) at end inspiration and end expiration and to calculate P-L. Measurements were taken during ventilation with CMV (CMVpre) after which patients were switched to HFOV with three 1-h different levels of mPaw set at +5, +10 and +15 cm H2O above the mean airway pressure measured during CMV. Patients were thereafter switched back to CMV (CMVpost).Results: Ten patients with moderate-to-severe ARDS were included. We demonstrated a linear increase in Pes and P-L with the increase in mPaw during HFOV. Contrary to CMV, P-L was always positive during HFOV whatever the level of mPaw applied but not associated with improvement in oxygenation. We found significant correlations between mPaw and Pes.Conclusion: HFOV with high level of mPaw increases transpulmonary pressures without improvement in oxygenation.