高频振荡通气在成年人急性呼吸窘迫综合征的临床应用

背景 高频振荡通气(high-frequency oscillatory ventilation,HFOV)作为一种新的通气模式,具有高频率、小潮气量、高平均气道压的特点,近年来被成功应用于成年人急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的治疗.研究表明,HFOV在改善氧合、减少呼吸机相关性肺损伤(ventilator associated lung injury,VILI)方面较常规机械通气(conventional mechanical ventilation,CMV)具有优势.但其对ARDS病死率的影响尚不明确. 目的 通过归纳HFOV在成年人ARDS中的临床应用揭示HFOV的优势和缺陷. 内容 HFOV能够高效改善氧合、减少VILI,但不能减少ARDS的病死率.HFOV技术的最适患者的筛选、最佳使用时机、最佳参数的设定以及与其他治疗手段联用等问题有待进一步探索. 趋向 HFOV应用于ARDS的治疗需要更加深入的研究和探索.

High-frequency oscillatory ventilation for adult patients with acute respiratory distress syndrome

Background As a new kind of ventilatory mode,high-frequency oscillatory ventilation (HFOV) is characterized by the rapid delivery of small tidal volumes cycling and high mean airway pressure.It has been successfully used in adults with the acute respiratory distress syndrome (ARDS).It has been shown that HFOV has advantages over conventional mechanical ventilation (CMV) in improving oxygenation and reducing the incidence of ventilator associated lung injury (VILI).However,the effect of HFOV on mortality still needs to be characterized.Objective To summarize the trials evaluating HFOV in adults with ARDS and reveal both the strengths and weaknesses of HFOV.Content HFOV is associated with significant improvement in oxygenation and prevention of VILI,however,not associated with reduction of mortality.Further researches are needed to identify optimal patient selection,timing,ventilator settings,and the role of combining HFOV with other interventions.Trend Further researches and explorations are needed to define the role of HFOV in adult ARDS.