Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation
Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation
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DOI：
10.1152/jappl.2001.91.4.1836
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发表时间：
2001-10-01
影响因子：
3.3
通讯作者：
Miyasaka, K
中科院分区：
文献类型：
--
作者：
Imai, Y;Nakagawa, S;Miyasaka, K
本研究采用生理盐水灌洗法建立家兔急性肺损伤模型，比较了不同治疗方案对肺损伤病理生理生化指标的影响。（10-12 ml/kg）和低呼气末正压（PEEP）（4-5 cm H（2）O）;和三个保护组：1）低VT（5-6 ml/kg）高PEEP，2-3 cmH（2）O大于下拐点; 2）低VT（5-6 ml/kg），高PEEP（8-10 cmH（2）O）; 3）高频振荡通气（HFOV）。采用PEEP >拐点的策略可导致低血压和气压伤。HFOV减轻了肺顺应性的降低、肺泡腔中多形核白细胞浸润和肿瘤坏死因子-α浓度评估的肺炎症以及小气道和肺泡的病理改变。采用肺保护策略（低VT高PEEP）的常规机械通气仅减轻了氧合和肺顺应性的降低。因此，HFOV可能是肺保护策略的优选选择。
This study compared pathophysiological and biochemical indexes of acute lung injury in a saline-lavaged rabbit model with different ventilatory strategies: a control group consisting of moderate tidal volume (VT) (10-12 ml/kg) and low positive end-expiratory pressure (PEEP) (4-5 cmH(2)O); and three protective groups: 1) low VT (5-6 ml/kg) high PEEP, 2-3 cmH(2)O greater than the lower inflection point; 2) low VT (5-6 ml/kg), high PEEP (8-10 cmH(2)O); and 3) high-frequency oscillatory ventilation (HFOV). The strategy using PEEP > inflection point resulted in hypotension and barotrauma. HFOV attenuated the decrease in pulmonary compliance, the lung inflammation assessed by polymorphonuclear leukocyte infiltration and tumor necrosis factor-alpha concentration in the alveolar space, and pathological changes of the small airways and alveoli. Conventional mechanical ventilation using lung protection strategies (low VT high PEEP) only attenuated the decrease in oxygenation and pulmonary compliance. Therefore, HFOV may be a preferable option as a lung protection strategy.