High-frequency oscillation in paediatric respiratory failure

High-frequency oscillatory ventilation (HFOV) allows effective recruitment of atelectasis while delivering minimal tidal volumes at rates exceeding the normal respiratory rate. HFOV is considered in the setting of failing conventional ventilation in patients with acute lung injury, indicated by arterial hypoxaemia despite peak inspiratory pressures of more than 35 cm H₂O or oxygenation indices of more than 13 on two or more arterial blood gas analyses. The initial mean airway pressure on HFOV is set 5–8 cm H₂0 higher than the last mean airway pressure during conventional ventilation. Increasing the mean airway pressure increases alveolar recruitment and oxygenation, whereas CO₂ elimination is directly related to the peak-to-trough pressure amplitude, and negatively correlated with the device frequency. Weaning from HFOV and the transition to conventional ventilation is considered on resolving lung disease and minimal settings on the oscillator (mean airway pressure 15−20 cm H₂O, amplitude ⩽4.0, FiO₂ <0.6).     

Inhaled prostacyclin and high-frequency oscillatory ventilation in a premature infant with respiratory syncytial virus-associated respiratory failure

In a 29-day-old premature infant with respiratory syncytial virus (RSV) pneumonia, we have shown an additive effect of high-frequency oscillatory ventilation (HFOV) and continuous inhalation of prostacyclin (iPGI(2)) with improvement of ventilation and oxygenation. The addition of continuous inhaled iPGI(2) to HFOV was beneficial in the treatment of hypoxemic respiratory failure owing to RSV-associated pneumonia. The improvement in alveolar recruitment by increasing lung expansion by HFOV along with less ventilation-perfusion mismatch by iPGI(2) appears to be responsible for the synergistic effect and favorable clinical outcome. We conclude that the combined therapy of HFOV and continuous inhaled iPGI(2) may be considered in RSV-associated hypoxemic respiratory failure in pediatric patients.     

High frequency oscillatory ventilation <Emphasis Type="Italic">versus</Emphasis> synchronized intermittent mandatory ventilation in preterm neonates with hyaline membrane disease: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

This randomized controlled study was conducted to compare the efficacy and safety of High frequency oscillatory ventilation (HFOV) and Synchronized intermittent mandatory ventilation (SIMV) in preterm neonates with hyaline membrane disease requiring ventilation. The ventilation strategy in both the groups included achieving optimal lung recruitment and targeted blood gases. 49 patients received HFOV and 61 SIMV. The baseline characteristics were similar in both the groups. HFOV group demonstrated better early oxygenation, enabled reduction in oxygenation index (OI) within 24 h of ventilation (difference in mean OI at 1, 6, and 24 h of ventilation: P=0.004 in HFOV, and 0.271 in SIMV group). Duration of hospital stay was shorter in HFOV group (P=0.003). The complication rate and survival were similar in two groups.     

High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome—early rescue use

In order to determine the response to high-frequency oscillatory ventilation (HFOV), used as an early rescue therapy, in a cohort of paediatric patients with acute respiratory distress syndrome (ARDS), a prospective clinical study was performed in a tertiary care paediatric intensive care unit. Ten consecutive patients, aged 12 days to 5 years with ARDS and hypoxaemic respiratory failure on conventional ventilation (CV), using a lung protective strategy, were managed with HFOV early in the course of the disease process (median length of CV 4 h). Arterial blood gases, oxygenation index (OI), alveolar-arterial oxygen difference (P(A-a)O₂) and PaO₂/FIO₂ ratio were prospectively recorded prior to HFOV (0 h) and at predetermined intervals throughout the course of the HFOV protocol. There was a significant improvement in PaCO₂ 4 h after institution of HFOV ( P =0.012). A significant and sustained increase ( P <0.001) in PaO₂/FIO₂ ratio and a significant and sustained decrease ( P <0.001) in OI and P(A-a)O₂ were demonstrated during the HFOV trial. These improvements were achieved 4 h after initiating HFOV ( P <0.05). Eight patients survived. There were no deaths from respiratory failure. Conclusion: In paediatric patients with acute respiratory distress syndrome and hypoxaemic respiratory failure on conventional ventilation, using a lung protective strategy, high-frequency oscillatory ventilation used as an early rescue therapy, improves gas exchange in a rapid and sustained fashion and provides a good outcome. Use of this therapy should probably be considered early in the course of the disease process.     

高频振荡通气联合肺表面活性物质治疗新生儿肺出血的疗效观察

目的 探讨高频振荡通气(HFOV)联合肺表面活性物质(PS)治疗新生儿肺出血(NPH)的临床疗效。方法 将2010 年1 月至2014 年6 月确诊为NPH 的122 例患儿,按胎龄分层后,随机分为HFOV+PS 治疗组(简称试验组)和单纯HFOV 治疗组(简称对照组),每组61 例。两组患儿均在发生NPH 后行HFOV,试验组在行HFOV 后2~4 h 给予气管内注入PS,然后继续HFOV。观察两组患儿上机时及上机后6、12、24 h 的血气分析、OI 值、PaO2/FiO2(P/F)值的动态变化,比较两组患儿的肺出血时间、上机时间、并发症和治愈率。结果 试验组在上机后6、12、24 h 的PaO2、PaCO2、OI 值、PaO2/FiO2(P/F)值均要优于对照组(P<0.05);试验组的肺出血停止时间及上机时间均短于对照组(P<0.01),且并发症发生率低于对照组(P<0.05);试验组治愈率(87%)与对照组(82%)相比差异无统计学意义(P>0.05)。结论 HFOV 联合PS 治疗NPH 可以改善氧合,缩短NPH 时间及上机时间,减少并发症的发生,但与单纯HFOV 相比并不能降低病死率。     

Combining lung-protective strategies in experimental acute lung injury: The impact of high-frequency partial liquid ventilation.

OBJECTIVE: To evaluate the independent and combined effects of high-frequency oscillatory ventilation (HFOV) and partial liquid ventilation (PLV) on gas exchange, pulmonary histopathology, inflammation, and oxidative tissue damage in an animal model of acute lung injury. DESIGN: Prospective, randomized animal study. SETTING: Research laboratory of a health sciences university. SUBJECTS: Fifty New Zealand White rabbits. INTERVENTIONS: Juvenile rabbits injured by lipopolysaccharide infusion and saline lung lavage were assigned to conventional ventilation (CMV), PLV, HFOV, or high-frequency partial liquid ventilation (HF-PLV) with a full or half dose (HF-PLV1/2) of perfluorochemical (PFC). Uninjured ventilated animals served as controls. Arterial blood gases were obtained every 30 mins during the 4-hr study. Histopathologic evaluation was performed using a lung injury scoring system. Oxidative lung injury was assessed by measuring malondialdehyde and 4-hydroxynonenal in lung homogenates. MEASUREMENTS AND MAIN RESULTS: HFOV, PLV, or a combination of both methods (HF-PLV) resulted in significantly improved oxygenation, more favorable lung histopathology, reduced neutrophil infiltration, and attenuated oxidative damage compared with CMV. HF-PLV with a full PFC dose did not provide any additional benefit compared with HFOV alone. HF-PLV1/2 was associated with decreased pulmonary leukostasis compared with HF-PLV. CONCLUSIONS: The combination of HFOV and PLV (HF-PLV) does not provide any additional benefit compared with HFOV or PLV alone in a combined model of lung injury when lung recruitment and volume optimization can be achieved. The use of a lower PFC dose (HF-PLV1/2) is associated with decreased pulmonary leukostasis compared with HF-PLV and deserves further study.     

High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn

We report on 50 term and near-term neonates (birth weight > 1800 g, gestational age > 33 weeks) with severe persistent pulmonary hypertension of the newborn (PPHN), referred to us from January 1987 to July 1991 after failure of maximum conventional treatment. All infants had paO₂<45 mm Hg when ventilated with peak inspiratory pressure >38 cm H₂O and FiO₂=1.0, hence meeting entry criteria for extracorporeal membrane oxygenation (ECMO). High frequency oscillatory ventilation (HFOV) was tried in all patients. If sufficient oxygenation could not be achieved (paO₂<40 mm Hg for at least 2 h), ECMO therapy was begun, which was the case in 25 children. Neonates responding to HFOV (n=25) were of a slightly younger gestational age (37.0 weeks vs 38.8 weeks,P<0.05), had higher Apgar scores and were less hypoxaemic before HFOV (paO₂ 36.6 mm Hg vs 28.8 mm Hg,P<0.01); during HFOV there was a significant rise in paO₂ (> 150 mm Hg;P<0.001) and a fall in pCO₂ to 21.6 mm Hg (P<0.001). Due to air leaks, which was the main complication of HFOV (52%), ECMO therapy had to be begun in two additional infants after an initial positive effect. HFOV tended to be successful in cases of primary PPHN, meconium aspiration and sepsis, but not in infants with lung hypoplasia as a result of diaphragmatic hernia or other reasons. Success or failure of HFOV could not be reliably predicted by any parameter. Mean duration of HFOV was 37.8 h vs 84.9 h of ECMO. PPHN could be overcome in 88% of the HFOV-treated and in 76% of the ECMO-treated infants; overall survival rate was 74% (predicted probability of survival using maximum conventional treatment <10%). There were no significant differences between HFOV/ECMO groups with regard to duration of ventilation following HFOV/ECMO, total time in hospital, rate of bronchopulmonary dysplasia and neurological complications (intracranial haemorrhage, brain infarction). Among the survivors, the rate of mentally handicapped children was equal in both groups (overall 18.9%). Our analysis shows that about 50% of neonates with PPHN who fail to respond to conventional ventilatory support and maximum treatment can be treated successfully with HFOV, thus avoiding ECMO. By applying both forms of therapy, the survival rate of infants with severe PPHN can be increased from an estimated rate of <10% up to 80%.     

Prenatal diagnosis of congenital diaphragmatic hernia and pulmonary hypoplasia and therapeutic strategy

The outcome of fetuses with congenital diaphragmatic hernia (CDH) has been reported to be fatal when pulmonary hypoplasia (PH) is severe. As an indicator of PH, we attempted to measure the lung-thorax transverse area ratio (L/T) using ultrasonic echography. Immediate postnatal surgery was performed using high-frequency oscillatory ventilation (HFOV) and sometimes followed by extracorporeal membrane oxygenation (ECMO). Eighteen fetuses were treated and 14 survived. L/T correlated well with the best preductal arterial blood gas data before surgical reduction during manual ventilation and HFOV, while preductal PO₂ and alveolar-arterial oxygen differences from patients managed with HFOV were better than those in patients with manual ventilation. Although L/T also correlated with the duration of O₂ therapy and hospitalization in survivors without major anomalies, there was no significant difference between L/T in survivors and nonsurvivors. Because delayed institution of ECMO and complications related to ECMO management seemed to be a major cause of death in non-survivors, the unsalvageable L/T due to PH was estimated to be below 0.06 for HFOV and below 0.1 for conventional ventilation based on the correlation between L/T and preductal P02. These results suggest that L/T is a useful indicator of PH in patients with CDH and also that HFOV is advantageous in treating CDH with PH. The advantage of prenatal diagnosis in predicting unsalvageable L/Ts, should be considered in the therapeutic strategy.     

Relationship between PaO2 and Lung Volume during High Frequency Oscillatory Ventilation

The relationship between oxygenation and lung volume during high frequency oscillatory ventilation (HFOV) was studied. We ventilated anesthetized, tracheostomized adult rabbits that were rendered surfactant-deficient by lung lavage. Lung volume was measured by the 'disconnection technique'. In the first experiment, HFOV was commenced after conventional mechanical ventilation (CM V) for 1 hr. In the absence of sustained inflation (SI), oxygenation improved with time during HFOV. In the second experiment, HFOV was instituted after CMV for 4hr. In the absence of SI, all animals expired during the experimental period. In the third experiment we ventilated rabbits for 4 hr and then switched to HFOV. We applied SI first and increased mean airway pressure (MAP) by increments of 2 cmH₂O every 15 min. However, there was little improvement in Pa_O2 despite the use of repeated SI and the increase in MAP. We conclude that oxygenation has a linear relationship to lung volume during HFOV, and that secondary lung injury due to long-term CMV impairs the response to HFOV. Therefore, it is important to minimize the risk of such secondary injuries before instituting HFOV.     

High frequency oscillatory ventilation in acute respiratory failure

High frequency oscillatory ventilation (HFOV) has emerged over the past 20 years as a safe and effective means of mechanical ventilatory support in patients with acute respiratory failure. During HFOV, lung recruitment is maintained by application of a relatively high mean airway pressure with superimposed pressure oscillations at a frequency of 3 to 15Hz, creating adequate ventilation using tidal volumes less than or equal to the patient's dead space volume. The physiologic rationale for the application of HFOV in the clinical arena comes from its ability to preserve end-expiratory lung volume while avoiding parenchymal overdistension at end-inspiration and theoretically limiting the potential for ventilator-associated lung injury. Data in the neonatal population suggests significant benefits in pulmonary outcomes when HFOV is applied with a recruitment strategy in preterm infants with respiratory distress syndrome (RDS). Use of HFOV in the paediatric and adult populations has not as yet been associated with significant improvements in clinically important outcome measures.     

Lung Function and Respiratory Health at School Age in Ventilated Very Low Birth Weight Infants

Objective

To investigate respiratory health and lung function in school-aged children without broncho-pulmonary dysplasia (BPD), who were very low birth weight (VLBWi) and randomized at birth to high frequency oscillatory ventilation (HFOV) or volume guarantee (VG) ventilation for severe respiratory distress syndrome (RDS).

Methods

In this observational study, 7-y-old ex-preterm infants with severe RDS, randomly assigned at birth to receive assisted/control ventilation?+?VG (Vt?=?5 mL/kg, PEEP?=?5 cmH₂O)(VG group; mean GA 27?±?2 wk; mean BW 1086?±?158 g) or HFOV (HFOV group; mean GA: 27?±?2; mean BW: 1090?±?139 g) (both groups were ventilated with Drager Babylog 8000 plus) were recalled. Neonatal clinical data and outcome were known. Actual outcomes were investigated with an interview; lung function was measured by whole-body plethysmography.

Results

Twenty five children were studied (VG group, n?=?13 vs. HFOV group, n?=?12). There were no differences in anthropometric data, drugs (steroids/bronchodilators and antibiotics) or hospital readmission for respiratory disorders. Compliance to the test was adequate. The authors found a similar obstructive deficit (elevated values: airway resistance (RAW), residual volume (RV), total lung capacity (TLC) with near-normal spirometry) in both groups suggesting a persistent airflow limitation even in absence of BPD.

Conclusions

VLBW infants even in absence of BPD, need long term respiratory follow-up, because they frequently show an impairment of lung function, independent from initial respiratory support, even if at birth the choice is a lung protective approach (e.g., HFOV or VG ventilation).     

High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure.

OBJECTIVE: To evaluate the effectiveness of high-frequency oscillatory ventilation (HFOV) in pediatric patients with acute respiratory failure, failing conventional ventilation. DESIGN: A prospective, clinical study. SETTING: Tertiary care pediatric intensive care unit. PATIENTS: Twenty pediatric patients (ages 12 days to 5 yrs) with acute respiratory failure (pneumonia, 14; sepsis with acute respiratory distress syndrome, 3; pulmonary edema as a complication of upper airway obstruction, 2; salicylate intoxication with acute respiratory distress syndrome, 1), failing conventional ventilation (median alveolar-arterial oxygen difference [P(A-a)O2] 578 [489-624] torr, median oxygenation index 26 [21-32]. INTERVENTIONS: HFOV was instituted after a median length of conventional ventilation of 15.5 (3.3-43.5) hrs. MEASUREMENTS AND MAIN RESULTS: Ventilator settings, arterial blood gases, oxygenation index, and P(A-a)O2 were recorded before HFOV (0 hrs) and at predetermined intervals during HFOV and compared using the one-way Friedman rank-sum procedure and a two-tailed Wilcoxon matched-pairs test. Initiation of HFOV caused a significant decrease in FiO2 at 1 hr that continued to 24 hrs (p 相似文献   

首选使用高频振荡通气治疗新生儿肺出血的临床效果分析

目的探讨首选高频振荡通气(HFOV)治疗新生儿肺出血的有效性及安全性。方法回顾性分析首选HFOV(首选组)和常频通气(CMV)治疗效果欠佳再换为HFOV解救性治疗(解救组)肺出血患儿26例的临床效果,比较两组患儿的氧合指数(OI)、肺出血时间、住院时间、上机时间、氧疗时间、合并症及转归变化。结果首选组治疗后1、6、12、24、48、72 h OI值明显低于解救组,差异有统计学意义(P0.05)。首选组呼吸机相关性肺炎(VAP)发生率明显低于解救组(P0.05),治愈率高于解救组(P0.05)。首选组气胸、颅内出血、消化道出血的发生率与解救组比较差异无统计学意义(P0.05)。存活患儿中,首选组在肺出血时间、住院时间、上机时间、氧疗时间上较解救组明显缩短(P0.05)。结论与解救组相比,首选HFOV较解救性使用HFOV能更好地改善肺出血患儿氧合功能,降低VAP的发生率,缩短病程,提高治愈率,且未增加不良反应的发生率。     

Innovative neonatal ventilation and meconium aspiration syndrome

Respiratory failure remains a major cause of morbidity and mortality in the neonatal population. Infants with hypoxemic respiratory failure because of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia/sepsis have a potential for increased survival with extracorporeal membrane oxygenation (ECMO). Other treatment options previously limited to inotropic support, conventional ventilatory management, respiratory alkalosis, paralysis and intravenous vasodilators have been replaced by high-frequency oscillatory ventilation (HFOV), surfactant, and inhaled nitric oxide (iNO). HFOV has been advocated for use to improve lung inflation while potentially decreasing lung injury through volutrauma. Other reports describe enhanced efficacy of HFOV when combined with iNO. Subsequent to studies reporting surfactant deficiency or inactivation may contribute to neonatal respiratory failure exogenous surfactant therapy has been implemented with apparent success. Recent studies have shown that iNO therapy in the neonate with hypoxemic respiratory failure can result in improved oxygenation and decreased need for ECMO. In this article, the authors place in context of a system-based strategy the prenatal, natal and postnatal management of babies delivered through meconium stained amniotic fluid (MSAF) so that adverse outcomes are minimized, and the least number of babies require innovative ventilatory support. At Pennsylvania Hospital, over a six-year period (1995 to 2000), 14.5% (3370/23,175 of live births babies were delivered with MSAF. These data show that 4.6% (155/3370) of babies with MSAF sustained MAS. Overall, 26% (40/155) of babies with MAS needed ventilatory support or 0.17% of all live-births); of these only 20% (8/40 or 0.035% of live births) needed innovative ventilatory support. None died or needed ECMO. These data describe the impact of a system-based approach to prevent and manage adverse outcomes related to MSAF at regional Level III perinatal center.     

Fetal diaphragmatic hernia: prenatal evaluation of lung hypoplasia and effects of immediate operation

The outcome of fetuses with diaphragmatic hernia (CDH) has been reported to be related to the severity of lung hypoplasia. As an index of pulmonary hypoplasia, we attempted to measure the lung-thorax transverse area ratio (L/T) using ultrasonic echography in eight fetuses with left-sided CDH. Two cases with L/T more than 0.28 (controls: 0.52±0.04) were transported postnatally and recovered after early operation without episodes of persistent fetal circulation. Elective surgical repair was performed in six infants immediately after cesarean delivery at 35–37 weeks' gestation. In three cases with L/T between 0.21 and 0.24 who recovered with no complications, surgical reduction of the abdominal organs improved arterial blood gases and high-frequency oscillation ventilation (HFOV) was fully effective for respiratory management. In three with L/T between 0.11 and 0.17, extracorporeal membrane oxygenation (ECMO) was required from the 1st to the 12th postoperative day despite HFOV. Although two infants died of combined cardiovascular anomalies and airway bleeding caused by prolonged HFOV, respectively, one infant with minimal L/T survived. Measurement of L/T may help to predict the outcome of fetuses with CDH and to determine the indications for various treatments including immediate operation after cesarean delivery, HFOV, and ECMO. Offprint requests to: S. Kamata     

目标容量控制通气治疗重症新生儿呼吸窘迫综合征的前瞻性随机对照研究

目的：评价目标容量控制通气治疗重症新生儿呼吸窘迫综合征（NRDS）的疗效。方法：将2008年6月至2010年1月收治的84例重症NRDS患儿随机分为3组：同步间歇正压加容量保证通气组（SIPPV+VG,31例）、高频振荡通气组（HFOV,23例）、间歇指令通气组（IMV,30例）。观察各组氧合情况、氧疗时间、呼吸机使用时间及并发症发生情况。结果：SIPPV+VG组、HFOV组患儿在上机12 h时氧合明显改善,P/F值、a/APO2与上机前比较差异有统计学意义（P<0.05）,而IMV组直至24 h氧合方有改善; SIPPV+VG、HFOV组患儿氧疗时间和呼吸机使用时间均低于IMV组（P<0.05）; SIPPV+VG、HFOV组患儿气漏和呼吸机相关性肺炎（VAP）的发生率均低于IMV组（P<0.05）;HFOV组III级以上颅内出血发生比率高于SIPPV+VG和IMV组。结论：SIPPV+VG和HFOV比IMV能更迅速地改善重症NRDS患儿氧合状况,缩短氧暴露和呼吸机应用时间,减少气漏、VAP的发生。     

Measuring tidal volume during paediatric oscillatory and jet high-frequency ventilation

ObjectiveTo ascertain whether a spirometer can measure tidal volume (TV) during high frequency oscillatory ventilation (HFOV) and high frequency jet ventilation (HFJV), and to analyse the effect of changes in ventilator settings.MethodsThe study was performed with paediatric porcine lung models submitted to HFOV with a Sensormedics 3100 ventilator and HFJV with a Paravent Pat_e^R ventilator connected to a D-Fend spirometer. Programmed frequency, amplitude, and mean airway pressure (MAP) were changed in the ventilator, and TV and pressures were recorded using the spirometer.ResultsThe spirometer measured TV in the paediatric lung models and piglets, but could not measure TV less than 8 ml, when the pressure amplitude was higher than 55 cmH₂O or the MAP was higher than 30 cmH₂O. With HFOV there was a correlation between amplitude and tidal volume, and a positive correlation between pressure and TV with HFJV. With both respirators there was a negative correlation between frequency and TV.ConclusionsThe D-Fend spirometer can measure tidal volume and pressure during HFOV and HFJV. However, it does not work with volumes lower than 8 ml, and high amplitude or mean airway pressure.     

High frequency oscillatory ventilation suppresses inflammatory response in lung tissue and microdissected alveolar macrophages in surfactant depleted piglets

The impact of high frequency oscillatory ventilation (HFOV) compared with intermittent mandatory ventilation (IMV) on oxygenation and pulmonary inflammatory response was studied in a surfactant depleted piglet model. After establishment of lung injury by bronchoalveolar lavage, piglets either received HFOV (n =5) or IMV (control; n = 5) for eight hours. PaO(2) was higher and mean pulmonary arterial pressure (MPAP) was lower with HFOV (HFOV versus control, mean +/- SEM; endpoint PaO(2): 252 +/- 73 versus 68 +/- 8.4 mm Hg; p < 0.001; MPAP: 22 +/- 2.3 versus 34 +/- 2.5 mm Hg; p < 0.01). mRNA expression of interleukin (IL)-1 beta, IL-6, IL-8, IL-10, TGF-beta 1, Endothelin-1, and adhesion molecules (E-selectin, P-selectin, ICAM-1) in lung tissue was quantified by real time PCR normalized to beta-actin and hypoxanthine-guanine-phosphoribosyl-transferase (HPRT). mRNA expression of all cytokines and adhesion molecules/HPRT was higher in controls (e.g.: HFOV versus control, mean +/- SEM; IL-1 beta/HPRT: 1.6 +/- 0.3 versus 23.1 +/- 8.6 relative units (RU), p < 0.001; IL-8/HPRT: 8.5 +/- 2.0 versus 63.5 +/- 15.2 RU, p < 0.001). IL-8/HPRT gene expression was quantified in microdissected single cells. With HFOV, IL-8 gene expression was highly reduced in alveolar macrophages: 10 +/- 3.4 copies IL-8 mRNA/copy HPRT mRNA versus 356 +/- 142; p < 0.05 (bronchiolar epithelial cells: 33 +/- 16 versus 208 +/- 108; alveolar septum: 2.1 +/- 1.3 versus 26 +/- 11; bronchiolar smooth muscle cells: 1.3 +/- 0.3 versus 2.8 +/- 1.0; vascular smooth muscle cells: 0.7 +/- 0.3 versus 1.1 +/- 0.4). In conclusion, HFOV improved oxygenation, reduced pulmonary arterial pressure and attenuated pulmonary inflammatory response.     

高频振荡通气在新生儿气胸治疗中的临床观察

目的：探讨高频振荡通气（HFOV）在新生儿气胸治疗中的疗效。方法：回顾性分析2007年1月至2011年6月接受HFOV治疗的23例新生儿气胸患儿的临床资料（HFOV组）,其中19例明确诊断后立即应用HFOV治疗,另4例因常频通气或持续气道正压通气治疗中出现气胸后改为HFOV。选取同期23例接受常频通气治疗的新生儿气胸患儿作为对照组。比较两组上机前、上机后1 h、12 h、24 h、48 h氧合指数（OI）、动脉/肺泡氧分压（a/APO2）以及上机时间、气胸吸收时间、合并症及转归。结果：两组呼吸机治疗后与上机前比较OI明显降低,a/APO2明显升高（P＜0.05）。HFOV组上机后1 h、12 h、24 h、48 h OI低于对照组,a/APO2高于对照组,（P＜0.05）。HFOV组上机时间、气胸吸收时间较对照组明显缩短（P＜0.05）。HFOV组治愈22例,对照组治愈21例。两组各出现呼吸机相关性肺炎1例,均在使用抗生素后治愈。结论：HFOV能更好地改善新生儿气胸患儿的氧合功能,缩短上机和气胸吸收时间,较常频通气治疗患儿并不增加不良反应的发生率。