High Frequency Oscillatory Ventilation in ARDS

描述（由申请人提供）：急性呼吸窘迫综合征（ARDS）在美国每年影响10 -20万人。这些患者中的绝大多数需要机械通气（MV）来维持生存。然而，MV可能加重肺损伤，延迟或阻止其他可治疗疾病的恢复，如创伤、败血症和肺炎。已经研究了几种“肺保护”策略来限制这种呼吸机相关损伤（VALI）。与更传统的方法相比，使用低潮气量（Vt）和吸气压力限制的传统通气可以改善结果。然而，Vt降低的程度是有限的，仍然保持足够的氧合和通气。另一种肺保护策略是高频振荡通气（HFOV），它使用非常小的高频Vts来实现有效的氧合和通气。然而，对于成人ARDS患者使用HFOV知之甚少。尽管一系列小型观察性研究和一项随机对照试验表明，HFOV可以安全地用于ARDS患者，但对呼吸机设置变化的生理反应尚不清楚。本申请中描述的项目旨在建立这些关系，以便设计一种高效的方案，将HFOV与目前ARDS通气患者的护理标准进行比较。

DESCRIPTION (provided by applicant): Acute respiratory distress syndrome (ARDS) affects 100,000-200,000 persons per year in the United States. The large majority of these patients require mechanical ventilation (MV) for survival. However, MV may exacerbate lung injury and delay or prevent recovery from otherwise treatable conditions such as trauma, sepsis, & pneumonia. Several "lung protective" strategies have been examined to limit this ventilator-associated injury (VALI). The use of conventional ventilation with low tidal volumes (Vt) and inspiratory pressure limitation has lead to improved outcomes when compared to more traditional approaches. However, the degree to which Vt can be reduced and still maintain adequate oxygenation and ventilation is limited. An alternative lung protective strategy is high frequency oscillatory ventilation (HFOV), which uses very small Vts at high frequency to achieve effective oxygenation and ventilation. However, little is known about the use of HFOV in adult patients with ARDS. Though a series of small observational studies and one randomized controlled trial suggest that HFOV can be safely administered to patients with ARDS, the physiologic responses to changes in ventilator settings are not well understood. The projects described in this application are designed to establish these relationships so that an efficient and effective protocol may be designed for the comparison of HFOV to the present standard of care among patients ventilated for ARDS.