Objective To compare effect of high-frequency oscillation ventilation (HFOV) and conventional mandatory ventilation (CMV) on lung injury development in rabbit with acute respiratory distress syndrome (ARDS). Methods A...Objective To compare effect of high-frequency oscillation ventilation (HFOV) and conventional mandatory ventilation (CMV) on lung injury development in rabbit with acute respiratory distress syndrome (ARDS). Methods Animals that underwent saline lung lavage to produce lung injury were randomized to one of the two treatment groups (HFOV or CMV, n=6). PaCO_ 2 was maintained between 35-45mmHg and arterial oxygen saturation (SaO_ 2) was maintain >88% by adjusting corresponding ventilator parameters. Ventilation period was 6h. Lung fluids were aspirated before and at the end of ventilation for cell analysis. Then the animals were euthanized, lung tissue was removed for wet/dry weight measurement, light and electron microscopic examination. Results The difference of artery blood gas analyses(pH, PaO_ 2, PaCO_ 2) between HFOV and CMV was insignificant. The difference between HFOV and CMV in cytological examination of lung fluids, wet/dry weight measurement was also insignificant. But compared with CMV,HFOV not only reduced the area of lung injury, but also reduced lung injury score in light and electron microscopic examination. Conclusion When same artery blood gas analysis was obtained, HFOV significantly reduced lung injury development in ARDS animal than CMV. As a lung protection strategy, HFOV can be used in the treatment of ARDS.展开更多
The effect of high frequency oscillatory ventilation（HFOV） at early stage on hemodynamic parameters, extravascular lung water（EVLW）, lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extr...The effect of high frequency oscillatory ventilation（HFOV） at early stage on hemodynamic parameters, extravascular lung water（EVLW）, lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome（ARDS） was explored. Central vein pressure（CVP） and pulse indicator continuous cardiac output（Pi CCO） were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS（ARDSp） and extrapulmonary ARDS（ARDSexp） models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index（EVLWI）, EVLW/intratroracic blood volume（ITBV） and pulmonary vascular permeability index（PVPI） were measured before and after modeling（T0 and T1）, and T2（1 h）, T3（2 h）, T4（3 h） and T5（4 h） after HFOV. CC16 and s ICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group（P〈0.05）. The EVLWI in ARDSp group was increased at T1（P=0.008）, and sustained continuously within 2 h（P=0.679, P=0.216）, but decreased at T4（P=0.007） and T5（P=0.037）. The EVLWI in ARDSexp group was also increased at T1（P=0.003）, but significantly decreased at T3（P=0.002） and T4（P=0.019）. PVPI was increased after modeling in both two groups（P=0.004, P=0.012）, but there was no significant change within 4 h（T5） under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI（P=0.13）, ΔPVPI（P=0.28） and ΔEVLW/ITBV between the two groups（P=0.63）. The significant decreases in both CC16 and s ICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.展开更多
Objective: High-frequency ventilation (HFV) is an effective means to achieve gas exchange in neonates. Adequate carbon dioxide (pCO<sub>2</sub>) levels are best achieved immediately after starting HFV, avo...Objective: High-frequency ventilation (HFV) is an effective means to achieve gas exchange in neonates. Adequate carbon dioxide (pCO<sub>2</sub>) levels are best achieved immediately after starting HFV, avoiding either hypercapnia or hypocapnia. We aimed to determine the initial pCO<sub>2</sub> levels after starting HFV, and the time taken to obtain the initial blood gas. Methods: We conducted an observational retrospective study on neonates that required their first episode of HFV. Data included the first blood gas result after starting HFV and when the gas was taken after starting HFV. Results: This study included 112 neonates with a median birth weight of 938 (IQR: 692 - 1549) grams and gestational age of 27.2 (24.6 - 30.7) weeks. The first pCO<sub>2</sub> after starting HFV (mean (SD)) was 53.7 (22) mmHg. Of 112, 15 (13.4%) showed initial hypocapnia (pCO<sub>2</sub> 35 mmHg), and 17 (15.2%) showed hypercapnia (pCO<sub>2</sub> > 65 mmHg)—a total of 28.6% unacceptable pCO<sub>2</sub> levels. Of 112, the first blood gas was obtained within 30 minutes in 47 (42%) and within one hour in 85 (76%), with a significant delay of two or more hours in eight (7.1%). Conclusion: Many neonates had unacceptable pCO<sub>2</sub> levels upon starting first-time HFV. There were significant delays in obtaining the initial gas.展开更多
The high frequency ventilation(HFV)can well support the breathing of respiratory patient with 20%-40%of normal tidal volume.Now as a therapy of rescue ventilation when conversional ventilation failed,the HFV has been ...The high frequency ventilation(HFV)can well support the breathing of respiratory patient with 20%-40%of normal tidal volume.Now as a therapy of rescue ventilation when conversional ventilation failed,the HFV has been applied in the treatments of severe patients with acute respiratory failure(ARF),acute respiratory distress syndrome(ARDS),etc.However,the gas exchange mechanism(GEM)of HFV is still not fully understood by researchers.In this paper,the GEM of HFV is reviewed to track the studies in the last decades and prospect for the next likely studies.And inspired by previous studies,the GEM of HFV is suggested to be continually developed with various hypotheses which will be testified in simulation,experiment and clinic trail.One of the significant measures is to study the GEM of HFV under the cross-disciplinary integration of medicine and engineering.Fully understanding the GEM can theoretically support and expand the applications of HFV,and is helpful in investigating the potential indications and contraindications of HFV.展开更多
Background High-frequency oscillatory ventilation （HFOV） allows for small tidal volumes at mean airway pressures （mPaw） above that of conventional mechanical ventilation （CMV）,but the effect of HFOV on hemodynam...Background High-frequency oscillatory ventilation （HFOV） allows for small tidal volumes at mean airway pressures （mPaw） above that of conventional mechanical ventilation （CMV）,but the effect of HFOV on hemodynamics,oxygen metabolism,and tissue perfusion in acute respiratory distress syndrome （ARDS） remains unclear.We investigated the effects of HFOV and CMV in sheep models with ARDS.Methods After inducing ARDS by repeated lavage,twelve adult sheep were randomly divided into a HFOV or CMV group.After stabilization,standard lung recruitments （40 cmH2O × 40 seconds） were performed.The optimal mPaw or positive end-expiratory pressure was obtained by lung recruitment and decremental positive end-expiratory pressure titration.The animals were then ventilated for 4 hours.The hemodynamics,tissue perfusion （superior mesenteric artery blood flow,pHi,and Pg-aCO2）,oxygen metabolism and respiratory mechanics were examined at baseline before saline lavage,in the ARDS model,after model stabilization,and during hourly mechanical ventilation for up to 4 hours.A two-way repeated measures analysis of variance was applied to evaluate differences between the groups.Results The titrated mPaw was higher and the tidal volumes lower in the HFOV group than the positive end-expiratory pressure in the CMV group.There was no significant difference in hemodynamic parameters between the HFOV and CMV groups.There was no difference in the mean alveolar pressure between the two groups.After lung recruitment,both groups showed an improvement in the oxygenation,oxygen delivery,and DO2.Lactate levels increased in both groups after inducing the ARDS model.Compared with the CMV group,the superior mesenteric artery blood flow and pHi were significantly higher in the HFOV group,but the Pg-aCO2 decreased in the HFOV group.Conclusion Compared with CMV,HFOV with optimal mPaw has no significant side effect on hemodynamics or oxygen metabolism,and increases gastric tissue blood perfusion.展开更多
Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO2) monitoring during jet ventilation for cardiac ablation. The use of tcPCO2 during cardiac ablation proce...Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO2) monitoring during jet ventilation for cardiac ablation. The use of tcPCO2 during cardiac ablation procedures offers the opportunity to compare end-tidal and transcutaneous methods of CO2 measurement before and after the use of the jet ventilation. Comparison of these measurements with arterial blood gas CO2 levels allows evaluation of the accuracy of the tcPCO2 technique for use during jet ventilation. Design: Observational study;patients served as their own controls. Setting: Cardiac electrophysiology laboratory. Participants: 15 adult patients (9 M), ASA III-IV, aged 26 to 82 years (median 66 years) undergoing radiofrequency ablation for atrial fibrillation. Interventions: Jet ventilation (JV) versus conventional ventilation. Measurements and Main Results: Paired measurements of end-tidal CO2 (EtCO2) and transcutaneous CO2 (tcPCO2) were recorded during periods of conventional ventilation. Paired measurements of arterial blood CO2 (PaCO2) levels and tcPCO2 were recorded during JV. ABG samples were drawn at the anesthesiologist’s discretion to assess the patient’s respiratory status. The level of agreement between the three methods was compared using the Bland Altman plot. We found that tcPCO2 values consistently provided a close approximation to PaCO2 levels. The mean difference between tcPCO2 and EtCO2 values in baseline and post-JV was on the order of 3 - 5 mmHg, with standard deviation of 4 - 6 mmHg. This is well within the range of variability that is accepted in clinical practice. Conclusions: These preliminary results suggest that tcPCO2 provides an acceptable estimate of CO2 concentration in arterial blood during JV, as well as prior to and following JV.展开更多
Hypoxemia during one-lung ventilation （OLV） is normal. Different ways of improving SpO2 on OLV include intermittent inflation ot the collapsed lung with oxygen, lung recruitment, and application of continuous positi...Hypoxemia during one-lung ventilation （OLV） is normal. Different ways of improving SpO2 on OLV include intermittent inflation ot the collapsed lung with oxygen, lung recruitment, and application of continuous positive airway pressure （CPAP） to the nondependent lung. This case report described the use of CPAP to the right lung, which was converted to high-frequency jet ventilation （HFJV） of the middle and lower lobes during fight upper lobe sleeve resection.展开更多
目的:对比研究容量目标通气、高频振荡通气两种模式在新生儿呼吸窘迫综合征中的治疗效果。方法:随机将2021年6月—2023年6月在湛江市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征患儿100例分为对照组与研究组,每组50例。研究组...目的:对比研究容量目标通气、高频振荡通气两种模式在新生儿呼吸窘迫综合征中的治疗效果。方法:随机将2021年6月—2023年6月在湛江市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征患儿100例分为对照组与研究组,每组50例。研究组采取高频振荡通气模式(高频机械通气+目标潮气量),对照组采取容量目标通气模式。对比两组动脉血气指标、并发症发生率、死亡率、有创通气时间、氧疗时间、住院时间。结果:研究组有创通气时间、氧疗时间、住院时间均短于对照组(P<0.05)。两组死亡率(0 vs 8.00%)比较,差异无统计学意义(P>0.05)。干预前两组血氧分压、血氧饱和度、pH值、二氧化碳分压比较,差异均无统计学意义(P>0.05);干预48 h后,研究组的血氧分压、血氧饱和度、pH值较干预前和对照组均更高,二氧化碳分压较干预前和对照组更低(P<0.05)。研究组的并发症发生率(10.00%)低于对照组(36.96%)(P<0.05)。结论:高频振荡通气模式可以更有效地改善新生儿呼吸窘迫综合征患儿动脉血气指标,缩短康复时间,减少各类并发症出现。展开更多
文摘Objective To compare effect of high-frequency oscillation ventilation (HFOV) and conventional mandatory ventilation (CMV) on lung injury development in rabbit with acute respiratory distress syndrome (ARDS). Methods Animals that underwent saline lung lavage to produce lung injury were randomized to one of the two treatment groups (HFOV or CMV, n=6). PaCO_ 2 was maintained between 35-45mmHg and arterial oxygen saturation (SaO_ 2) was maintain >88% by adjusting corresponding ventilator parameters. Ventilation period was 6h. Lung fluids were aspirated before and at the end of ventilation for cell analysis. Then the animals were euthanized, lung tissue was removed for wet/dry weight measurement, light and electron microscopic examination. Results The difference of artery blood gas analyses(pH, PaO_ 2, PaCO_ 2) between HFOV and CMV was insignificant. The difference between HFOV and CMV in cytological examination of lung fluids, wet/dry weight measurement was also insignificant. But compared with CMV,HFOV not only reduced the area of lung injury, but also reduced lung injury score in light and electron microscopic examination. Conclusion When same artery blood gas analysis was obtained, HFOV significantly reduced lung injury development in ARDS animal than CMV. As a lung protection strategy, HFOV can be used in the treatment of ARDS.
文摘The effect of high frequency oscillatory ventilation（HFOV） at early stage on hemodynamic parameters, extravascular lung water（EVLW）, lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome（ARDS） was explored. Central vein pressure（CVP） and pulse indicator continuous cardiac output（Pi CCO） were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS（ARDSp） and extrapulmonary ARDS（ARDSexp） models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index（EVLWI）, EVLW/intratroracic blood volume（ITBV） and pulmonary vascular permeability index（PVPI） were measured before and after modeling（T0 and T1）, and T2（1 h）, T3（2 h）, T4（3 h） and T5（4 h） after HFOV. CC16 and s ICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group（P〈0.05）. The EVLWI in ARDSp group was increased at T1（P=0.008）, and sustained continuously within 2 h（P=0.679, P=0.216）, but decreased at T4（P=0.007） and T5（P=0.037）. The EVLWI in ARDSexp group was also increased at T1（P=0.003）, but significantly decreased at T3（P=0.002） and T4（P=0.019）. PVPI was increased after modeling in both two groups（P=0.004, P=0.012）, but there was no significant change within 4 h（T5） under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI（P=0.13）, ΔPVPI（P=0.28） and ΔEVLW/ITBV between the two groups（P=0.63）. The significant decreases in both CC16 and s ICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.
文摘Objective: High-frequency ventilation (HFV) is an effective means to achieve gas exchange in neonates. Adequate carbon dioxide (pCO<sub>2</sub>) levels are best achieved immediately after starting HFV, avoiding either hypercapnia or hypocapnia. We aimed to determine the initial pCO<sub>2</sub> levels after starting HFV, and the time taken to obtain the initial blood gas. Methods: We conducted an observational retrospective study on neonates that required their first episode of HFV. Data included the first blood gas result after starting HFV and when the gas was taken after starting HFV. Results: This study included 112 neonates with a median birth weight of 938 (IQR: 692 - 1549) grams and gestational age of 27.2 (24.6 - 30.7) weeks. The first pCO<sub>2</sub> after starting HFV (mean (SD)) was 53.7 (22) mmHg. Of 112, 15 (13.4%) showed initial hypocapnia (pCO<sub>2</sub> 35 mmHg), and 17 (15.2%) showed hypercapnia (pCO<sub>2</sub> > 65 mmHg)—a total of 28.6% unacceptable pCO<sub>2</sub> levels. Of 112, the first blood gas was obtained within 30 minutes in 47 (42%) and within one hour in 85 (76%), with a significant delay of two or more hours in eight (7.1%). Conclusion: Many neonates had unacceptable pCO<sub>2</sub> levels upon starting first-time HFV. There were significant delays in obtaining the initial gas.
基金the Natural Science Foundation of Hunan,China(No.2020JJ4159)the Research Foundation of Education Bureau of Hunan,China(No.19A093)+1 种基金the Interdisciplinary Program of Shanghai Jiao Tong University(No.YG2019ZDB08)the Significant Special Project form Ministry of Science and Technology of China(No.2021YFC0122500)。
文摘The high frequency ventilation(HFV)can well support the breathing of respiratory patient with 20%-40%of normal tidal volume.Now as a therapy of rescue ventilation when conversional ventilation failed,the HFV has been applied in the treatments of severe patients with acute respiratory failure(ARF),acute respiratory distress syndrome(ARDS),etc.However,the gas exchange mechanism(GEM)of HFV is still not fully understood by researchers.In this paper,the GEM of HFV is reviewed to track the studies in the last decades and prospect for the next likely studies.And inspired by previous studies,the GEM of HFV is suggested to be continually developed with various hypotheses which will be testified in simulation,experiment and clinic trail.One of the significant measures is to study the GEM of HFV under the cross-disciplinary integration of medicine and engineering.Fully understanding the GEM can theoretically support and expand the applications of HFV,and is helpful in investigating the potential indications and contraindications of HFV.
基金This study was supported by the grants from the National Natural Science Foundation of China （No. 81372093 and No. 81370180）, the Foundation of Jiangsu Province Department of Health （No. H201432） and the Special Fund for Health-Scientific Research in the Public Interest Program from Ministry of Health, China （No. 20120201 !）.
文摘Background High-frequency oscillatory ventilation （HFOV） allows for small tidal volumes at mean airway pressures （mPaw） above that of conventional mechanical ventilation （CMV）,but the effect of HFOV on hemodynamics,oxygen metabolism,and tissue perfusion in acute respiratory distress syndrome （ARDS） remains unclear.We investigated the effects of HFOV and CMV in sheep models with ARDS.Methods After inducing ARDS by repeated lavage,twelve adult sheep were randomly divided into a HFOV or CMV group.After stabilization,standard lung recruitments （40 cmH2O × 40 seconds） were performed.The optimal mPaw or positive end-expiratory pressure was obtained by lung recruitment and decremental positive end-expiratory pressure titration.The animals were then ventilated for 4 hours.The hemodynamics,tissue perfusion （superior mesenteric artery blood flow,pHi,and Pg-aCO2）,oxygen metabolism and respiratory mechanics were examined at baseline before saline lavage,in the ARDS model,after model stabilization,and during hourly mechanical ventilation for up to 4 hours.A two-way repeated measures analysis of variance was applied to evaluate differences between the groups.Results The titrated mPaw was higher and the tidal volumes lower in the HFOV group than the positive end-expiratory pressure in the CMV group.There was no significant difference in hemodynamic parameters between the HFOV and CMV groups.There was no difference in the mean alveolar pressure between the two groups.After lung recruitment,both groups showed an improvement in the oxygenation,oxygen delivery,and DO2.Lactate levels increased in both groups after inducing the ARDS model.Compared with the CMV group,the superior mesenteric artery blood flow and pHi were significantly higher in the HFOV group,but the Pg-aCO2 decreased in the HFOV group.Conclusion Compared with CMV,HFOV with optimal mPaw has no significant side effect on hemodynamics or oxygen metabolism,and increases gastric tissue blood perfusion.
文摘Objectives: There is no data in the current medical literature on efficacy or accuracy of transcutaneous (tcPCO2) monitoring during jet ventilation for cardiac ablation. The use of tcPCO2 during cardiac ablation procedures offers the opportunity to compare end-tidal and transcutaneous methods of CO2 measurement before and after the use of the jet ventilation. Comparison of these measurements with arterial blood gas CO2 levels allows evaluation of the accuracy of the tcPCO2 technique for use during jet ventilation. Design: Observational study;patients served as their own controls. Setting: Cardiac electrophysiology laboratory. Participants: 15 adult patients (9 M), ASA III-IV, aged 26 to 82 years (median 66 years) undergoing radiofrequency ablation for atrial fibrillation. Interventions: Jet ventilation (JV) versus conventional ventilation. Measurements and Main Results: Paired measurements of end-tidal CO2 (EtCO2) and transcutaneous CO2 (tcPCO2) were recorded during periods of conventional ventilation. Paired measurements of arterial blood CO2 (PaCO2) levels and tcPCO2 were recorded during JV. ABG samples were drawn at the anesthesiologist’s discretion to assess the patient’s respiratory status. The level of agreement between the three methods was compared using the Bland Altman plot. We found that tcPCO2 values consistently provided a close approximation to PaCO2 levels. The mean difference between tcPCO2 and EtCO2 values in baseline and post-JV was on the order of 3 - 5 mmHg, with standard deviation of 4 - 6 mmHg. This is well within the range of variability that is accepted in clinical practice. Conclusions: These preliminary results suggest that tcPCO2 provides an acceptable estimate of CO2 concentration in arterial blood during JV, as well as prior to and following JV.
文摘Hypoxemia during one-lung ventilation （OLV） is normal. Different ways of improving SpO2 on OLV include intermittent inflation ot the collapsed lung with oxygen, lung recruitment, and application of continuous positive airway pressure （CPAP） to the nondependent lung. This case report described the use of CPAP to the right lung, which was converted to high-frequency jet ventilation （HFJV） of the middle and lower lobes during fight upper lobe sleeve resection.
文摘目的:对比研究容量目标通气、高频振荡通气两种模式在新生儿呼吸窘迫综合征中的治疗效果。方法:随机将2021年6月—2023年6月在湛江市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征患儿100例分为对照组与研究组,每组50例。研究组采取高频振荡通气模式(高频机械通气+目标潮气量),对照组采取容量目标通气模式。对比两组动脉血气指标、并发症发生率、死亡率、有创通气时间、氧疗时间、住院时间。结果:研究组有创通气时间、氧疗时间、住院时间均短于对照组(P<0.05)。两组死亡率(0 vs 8.00%)比较,差异无统计学意义(P>0.05)。干预前两组血氧分压、血氧饱和度、pH值、二氧化碳分压比较,差异均无统计学意义(P>0.05);干预48 h后,研究组的血氧分压、血氧饱和度、pH值较干预前和对照组均更高,二氧化碳分压较干预前和对照组更低(P<0.05)。研究组的并发症发生率(10.00%)低于对照组(36.96%)(P<0.05)。结论:高频振荡通气模式可以更有效地改善新生儿呼吸窘迫综合征患儿动脉血气指标,缩短康复时间,减少各类并发症出现。
