Acute effects of combined high-frequency oscillation and tracheal gas insufflation in severe acute respiratory distress syndrome

被引:29
|
作者
Mentzelopoulos, Spyros D. [1 ]
Roussos, Charis [1 ]
Koutsoukou, Antonia [1 ]
Sourlas, Sotiris [1 ]
Malachias, Sotiris [1 ]
Lachana, Alexandra [1 ]
Zakynthinos, Spyros G. [1 ]
机构
[1] Univ Athens, Sch Med, Dept Crit Care 1, Athens, Greece
关键词
respiratory distress syndrome; adult; high-frequency ventilation;
D O I
10.1097/01.CCM.0000265738.80832.BE
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective. In acute respiratory distress syndrome (ARDS), high-frequency oscillation (HFO) improves oxygenation relative to conventional mechanical ventilation (CMV). Alveolar ventilation is improved by adding tracheal gas insufflation (TGI) to CMV. We hypothesized that combined HFO and TGI (HFO-TGI) might result in improved gas exchange relative to both standard HFO and CMV according to the ARDS Network protocol. Design: Prospective, randomized, crossover study, Setting. A 30-bed university intensive care unit. Patients: A total of 14 patients with early (< 72 hrs in duration), severe (PaO2/FIO2 of < 150 mm Hg and prerecruitment oxygenation index of 22.8 +/- 1.9 [mean +/- SEM]), primary ARDS. Interventions. Patients were ventilated with HFO without (60 mins) and combined with TGI (6.1 +/- 0.1 L/min, 60 mins) in random order. HFO sessions were repeated in inverse order within 24 hrs. HFO sessions were preceded and followed by ARDS Network CMV. Four recruitment maneuvers were performed during the study period. During HFO sessions, mean airway pressure was set at 1 cm H2O above the point of maximal curvature of the respiratory system expiratory pressure-volume curve. Measurements and Main Results: Gas exchange and hemodynamics were determined before, during, and after HFO sessions. HFO-TGI improved PaO2/FIO2 relative to HFO and CMV (174.5 +/- 10.4 vs. 136.0 +/- 10.0 and 105.0 +/- 3.7 mm Hg, respectively, p < .05 for both) and oxygenation index relative to HFO (17.1 +/- 1.3 vs. 22.3 +/- 1.7, respectively p < .05). PaO2/FIO2 returned to baseline within 3 hrs after HFO. During HFO-TGI, shunt fraction and mixed venous oxygen saturation improved relative to CMV (0.36 +/- 0.01 vs. 0.45 +/- 0.01 and 77.8% +/- 1.2% vs. 71.8% +/- 1.30/6, respectively, p < .05 for both). PaCO2 and hemodynamics were unaffected by HFO sessions. Respiratory mechanics remained unchanged throughout the study period. Conclusions. In early onset, primary, severe ARDS, short-term HFO-TGI improves oxygenation relative to standard HFO and ARDS Network CMV.
引用
收藏
页码:1500 / 1508
页数:9
相关论文
共 50 条
  • [31] High-frequency oscillation ventilation for hypercapnic failure of conventional ventilation in pulmonary acute respiratory distress syndrome
    Sigrun Friesecke
    Stephanie-Susanne Stecher
    Peter Abel
    Critical Care, 19
  • [32] High-frequency oscillatory ventilation in adult acute respiratory distress syndrome
    David, M
    Weiler, N
    Heinrichs, W
    Neumann, M
    Joost, T
    Markstaller, K
    Eberle, B
    INTENSIVE CARE MEDICINE, 2003, 29 (10) : 1656 - 1665
  • [33] High-frequency oscillatory ventilation in adults with acute respiratory distress syndrome
    Hager, David N.
    CURRENT OPINION IN ANESTHESIOLOGY, 2012, 25 (01) : 17 - 23
  • [34] High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults
    Derdak, S
    Mehta, S
    Stewart, TE
    Smith, T
    Rogers, M
    Buchman, TG
    Carlin, B
    Lowson, S
    Granton, J
    AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2002, 166 (06) : 801 - 808
  • [35] High-frequency oscillatory ventilation in adult acute respiratory distress syndrome
    Matthias David
    Norbert Weiler
    Wolfgang Heinrichs
    Markus Neumann
    Thilo Joost
    Klaus Markstaller
    Balthasar Eberle
    Intensive Care Medicine, 2003, 29 : 1656 - 1665
  • [36] Effect of frequency on lung protection during high-frequency oscillation ventilation in a sheep acute respiratory distress syndrome model
    S Liu
    H Qiu
    Y Yang
    Q Chen
    Critical Care, 12 (Suppl 2):
  • [37] High-frequency oscillation in early adult respiratory distress syndrome
    Taki, Kahoko
    Huang, David T.
    CRITICAL CARE, 2014, 18 (03):
  • [38] High-frequency oscillation in early adult respiratory distress syndrome
    Kahoko Taki
    David T Huang
    Critical Care, 18
  • [39] The clinical effects of high-frequency oscillatory ventilation in the treatment of neonatal severe meconium aspiration syndrome complicated with severe acute respiratory distress syndrome
    Guang Yang
    Yunxia Qiao
    Xinxin Sun
    Tiandan Yang
    Aiying Lv
    Min Deng
    BMC Pediatrics, 21
  • [40] The clinical effects of high-frequency oscillatory ventilation in the treatment of neonatal severe meconium aspiration syndrome complicated with severe acute respiratory distress syndrome
    Yang, Guang
    Qiao, Yunxia
    Sun, Xinxin
    Yang, Tiandan
    Lv, Aiying
    Deng, Min
    BMC PEDIATRICS, 2021, 21 (01)