High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation
High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation
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DOI：
10.1097/01.ccm.0000251128.60336.fe
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发表时间：
2007-01-01
影响因子：
8.8
通讯作者：
Papazian, Laurent
中科院分区：
文献类型：
--
作者：
Demory, Didier;Michelet, Pierre;Papazian, Laurent
Objective.当急性呼吸窘迫综合征（ARDS）患者转为仰卧位时，俯卧位对氧合的改善并不持久。高频振荡通气（HFOV）旨在通过应用恒定的平均气道压力来维持开放肺容量。本研究的目的是表明，当ARDS患者从俯卧位转回到仰卧位时，HFOV能够防止氧合损伤。前瞻性、比较性随机研究。一个医学重症监护病房。患者：43名ARDS患者，PaO 2/FIO 2比值< 150 at positive end-expiratory pressure >= 5 cm H2O。在优化期后，患者被分配到三组中的一组：a）俯卧位常规肺保护性机械通气（12小时），随后是仰卧位常规肺保护性机械通气12小时（CVproone-CVsupine）; B）仰卧位常规肺保护性机械通气（12小时），随后仰卧位HFOV（12小时）（CV仰卧-HFOV仰卧）;或c）俯卧位常规肺保护性机械通气（12小时），随后仰卧位HFOV（CV俯卧-HFOV仰卧组）。研究结束时，CVproone-HFO-CVsupine组Pao（2）/FIO 2比值高于CVproone-CVsupine组（p
Objective. The improvement in oxygenation with prone positioning is not persistent when patients with acute respiratory distress syndrome (ARDS) are turned supine. High-frequency oscillatory ventilation (HFOV) aims to maintain an open lung volume by the application of a constant mean airway pressure. The aim of this study was to show that HFOV is able to prevent the impairment in oxygenation when ARDS patients are turned back from the prone to the supine position.Design., Prospective, comparative randomized study.Setting. A medical intensive care unit.Patients: Forty-three ARDS patients with a PaO2/FIO2 ratio < 150 at positive end-expiratory pressure >= 5 cm H2O.Interventions. After an optimization period, the patients were assigned to one of three groups: a) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by a 12-hr period of conventional lung-protective mechanical ventilation in the supine position (CVprone-CVsupine\); b) conventional lung-protective mechanical ventilation in the supine position (12 hrs) followed by HFOV in the supine position (12 hrs) (CVsupine-HFOVsupine); or c) conventional lung-protective mechanical ventilation in the prone position (12 hrs) followed by HFOV in the supine position (CVprone-HFOVsupine group).Measurements and Main Results. Pao(2)/FIO2 ratio was higher at the end of the study period in the CVprone-HFOVsupine, group than in the CVprone-CVsupine group (p