Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome
Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome
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DOI：
10.1164/ajrccm.165.6.2003052
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发表时间：
2002-03-15
影响因子：
24.7
通讯作者：
Bartlett, RH
中科院分区：
文献类型：
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作者：
Hirschl, RB;Croce, M;Bartlett, RH
我们在一项多中心、前瞻性、对照、随机的探索性临床试验中评估了全氟隆部分液体通气（PLV）对急性肺损伤和急性呼吸窘迫综合征（ARDS）成年患者的安全性和有效性。90例Pa-O2/Fl（O2）比率为bbb60和< 300且ARDS持续时间不超过24小时的成年患者随机接受PLV治疗（n = 65），并通过气管内管侧口或常规机械通气（CMV, n = 25）给予全氟肺，最多持续5天。虽然PLV患者的ARDS进展明显减少，但在28天不使用呼吸机的天数（CMV = 6.7 +/- 1.8天，PLV = 6.3 +/- 1.0天，p = 0.85）、死亡率（CMV = 36%, PLV = 42%, p = 0.63）或任何肺部相关参数方面没有观察到显著差异。在一项特设亚组分析中，55岁以下急性肺损伤或ARDS患者在PLV期间，机械通气停药速度明显加快（p = 0.045）， 28天无呼吸机天数呈增加趋势（CMV = 3.2 +/- 1.9, PLV = 8.0 +/- 2.2天，p = 0.06）。PLV组更常出现缺氧、呼吸性酸中毒和心动过缓，但这些都是短暂的和自限性的。有必要对PLV进行进一步评估，以进一步确定在明确的患者群体中的有益效果，并获得有关安全性的额外信息。
We evaluated the safety and efficacy of partial liquid ventilation (PLV) with perflubron in adult patients with acute lung injury and the acute respiratory distress syndrome (ARDS) in a multicenter, prospective, controlled, randomized exploratory clinical trial. Ninety adult patients with Pa-O2/Fl(O2) ratios > 60 and < 300 with ARDS for no more than 24 hours were randomized to receive PLV (n = 65) with administration of perflubron through an endotracheal tube sideport or conventional mechanical ventilation (CMV, n = 25) for a maximum of five days. Although a significant reduction in progression to ARDS was noted among patients with PLV, no significant differences in the number of days free from the ventilator at 28 days (CMV = 6.7 +/- 1.8, PLV = 6.3 +/- 1.0 days, p = 0.85), the incidence of mortality (CMV = 36%, PLV = 42%, p = 0.63), or any pulmonary-related parameter were observed. During a post hoc subgroup analysis, significantly more rapid discontinuation of mechanical ventilation (p = 0.045) and a trend toward an increase in the number of days free from the ventilator at 28 days (CMV = 3.2 +/- 1.9, PLV = 8.0 +/- 2.2 days, p = 0.06) were observed during PLV among those patients under 55 years of age with acute lung injury or ARDS. Episodes of hypoxia, respiratory acidosis, and bradycardia occurred more frequently in the PLV group, but these were transient and self-limited. Further evaluation of PLV is warranted to further define beneficial effects in well-defined groups of patients and also to gain additional information regarding safety.