急性呼吸窘迫综合征与高频震荡通气

High frequency oscillatory ventilation for acute respiratory distress syndrome

高频振荡通气(HFOV)治疗急性呼吸窘迫综合征(ARDS), 患者人群不同, 临床研究状态及证据水平差异明显。HFOV治疗成人ARDS:目前临床研究证据显示, 不推荐HFOV常规用于成人ARDS机械通气治疗。HFOV治疗儿童ARDS:目前既无充分证据显示HFOV优于常规机械通气;也未能证明HFOV有害无益。目前的推荐意见是"在常规机械通气平台压超过28 cmH2O(1 cmH2O=0.098 kPa)且无胸壁顺应性降低证据的中重度ARDS患者, HFOV可作为替代性机械通气治疗模式"。HFOV治疗新生儿ARDS:有较为充分的高质量临床研究, 现有研究证据显示HFOV在早产儿ARDS治疗中能适度减少慢性肺疾病的发生;急性期改善氧合、减轻机械通气相关肺损伤有一定优势;远期对肺功能恢复及神经功能发育也有一定优势。

High frequency oscillatory ventilation(HFOV)in the treatment of acute respiratory distress syndrome(ARDS),there are significant differences in clinical research status and evidence level among different participants.HFOV for adult ARDS:current clinical evidence suggests that HFOV is not recommended for routine mechanical ventilation in adults with ARDS.HFOV for pediatric ARDS:there is no sufficient evidence to show that HFOV is superior to conventional mechanical ventilation.Nor does it prove that HFOV is harmful.The current recommendation is:HFOV could be considered as an alternative ventilatory mode in patients with moderate-to-severe pediatric ARDS,whom with conventional mechanical ventilation plateau airway pressures exceed 28 cmH2O(1 cmH2O=0.098 kPa)in the absence of clinical evidence of reduced chest wall compliance.HFOV for neonatal ARDS:the existing research evidence shows that HFOV can moderately reduce the incidence of chronic lung disease in the premature infants with neonatal ARDS.It has certain advantages in improving oxygenation and alleviating ventilator induced lung injury in acute phase.It also has certain advantages for improving pulmonary function and neurodevelopmental in the long term.