High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults
High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults
复制标题
DOI：
10.1164/rccm.2108052
复制
发表时间：
2002-09-15
影响因子：
24.7
通讯作者：
Granton, J
中科院分区：
文献类型：
--
作者：
Derdak, S;Mehta, S;Granton, J
观察性研究表明，高频振荡通气对急性呼吸窘迫综合征成人的氧合改善。我们设计了一项多中心、随机、对照试验，比较高频振荡通气与常规通气对急性呼吸窘迫综合征成人的安全性和有效性；148例急性呼吸窘迫综合征（Pa-O2/吸入氧分数小于或等于200 mm Hg，呼气末正压≥10 cm H2O）的成人随机分为高频振荡通气组（n = 75）和常规通气组（n = 73）。在前72小时内，高频振荡组的平均气道压力明显高于常规通气组（p = 0.0001）。与常规通气组相比，高频振荡组Pa-O2/吸入氧分数较常规通气组早期（≤16 h）改善（p = 0.008）；然而，这种差异并没有持续超过24小时。在头72小时内，两组的氧合指数下降相似。高频振荡组30天死亡率为37%，常规通气组为52% （p = 0.102）。高频振荡组和常规通气组30 d无机械通气存活患者比例分别为36%和31% （p = 0.686）。两组间血流动力学指标、氧合失败、通气失败、气压损伤、黏液堵塞无显著差异。我们认为高频振荡通气是治疗成人急性呼吸窘迫综合征的一种安全有效的通气方式。
Observational studies of high-frequency oscillatory ventilation in adults with the acute respiratory distress syndrome have demonstrated improvements in oxygenation. We designed a multicenter, randomized, controlled trial comparing the safety and effectiveness of high-frequency oscillatory ventilation with conventional ventilation in adults with acute respiratory distress syndrome; 148 adults with acute respiratory distress syndrome (Pa-O2/fraction of inspired oxygen less than or equal to 200 mm Hg on 10 or more cm H2O positive end-expiratory pressure) were randomized to high-frequency oscillatory ventilation (n = 75) or conventional ventilation (n = 73). Applied mean airway pressure was significantly higher in the high-frequency oscillation group compared with the conventional ventilation group throughout the first 72 hours (p = 0.0001). The high-frequency oscillation group showed early (less than 16 hours) improvement in Pa-O2/fraction of inspired oxygen compared with the conventional ventilation group (p = 0.008); however, this difference did not persist beyond 24 hours. Oxygenation index decreased similarly over the first 72 hours in both groups. Thirty-day mortality was 37% in the high-frequency oscillation group and was 52% in the conventional ventilation group (p = 0.102). The percentage of patients alive without mechanical ventilation at Day 30 was 36% and 31% in the high-frequency oscillation and conventional ventilation groups, respectively (p = 0.686). There were no significant differences in hemodynamic variables, oxygenation failure, ventilation failure, barotraumas, or mucus plugging between treatment groups. We conclude that high-frequency oscillation is a safe and effective mode of ventilation for the treatment of acute respiratory distress syndrome in adults.