High-Frequency Oscillatory Ventilation in Adult Patients with Acute Respiratory Distress Syndrome Plus Air-Leak Syndrome

高頻振盪呼吸器在成人急性呼吸窘迫症併發肺部漏氣之應用

王秉槐(Ping-Huai Wang) ； 余忠仁(Chong-Jen Yu) ； 吳惠東(Huey-Dong Wu) ； 楊泮池(Pan-Chyr Yang)

《胸腔醫學》 18卷5期 (2003/10) Pp. 419-426

https://doi.org/10.29806/TM.200310.0005

摘要

簡介：根據目前的研究發現高頻振盪呼吸器用於治療罹患急性呼吸窘迫症的成人病患，可以改善肺部氣體交換，這篇研究的目的在於評估高頻振盪呼吸器用在罹患急性呼吸窘迫症的成人病患併發肺部漏氣之效果。
方法：自1999年一月至2002年八月，一共有17位成年病人罹患急性呼吸窘迫症併發肺部漏氣，其中四人因為使用傳統呼吸器並無法維持適當的氣體交換，而改用高頻振盪呼吸器，其餘13人持續使用傳統呼吸器，動脈血氧分析的變化及加護病房的死亡率加以紀錄及分析。
結果：在肺部漏氣之後，呼氣末正壓壓力有顯著的下降，但血液的二氧化碳分壓及氧氣指數（PaO2/FiO2）並沒有受到肺部漏氣的影響。在改用高頻振盪呼吸器後，病患血液的二氧化碳分壓及氧氣指數（PaO2/FiO2）有改善的趨勢。在兩組病人的死亡率而言，使用高頻振盪呼吸器的是50%，而使用傳統呼吸器的是92.3%。
結論：當成人急性呼吸窘迫症併發肺部漏氣，同時傳統呼吸器無法維持適當的氣體交換時，高頻振盪呼吸器似乎是一種可以嘗試的一種治療方法。

並列摘要

Objective: There have been a limited number of studies on the improvement of gas exchange in adult patients with acute respiratory distress syndrome (ARDS) through the use of high-frequency oscillatory ventilation (HFOV). The aim of this study was to evaluate the efficacy of HFOV as a rescue therapy in adult patients with ARDS complicated by air-leak syndrome.
Method: From January 1999 to August 2002, 17 adult ARDS patients with air leakage were diagnosed in the medical intensive care unit (ICU). Four patients underwent HFOV due to refractory hypoxemia and/or hypercapnia under conventional ventilation (CV). The other 13 patients continued CV support. The changes in gas exchange and ICU mortality were analyzed. All of the data are expressed as mean ± SEM.
Results: In all subjects, positive end-expiratory pressure and peak inspiratory pressure were significantly lower one day after air leakage (p=0.005 and p=0.033, respectively). PaCO2 and PaO2/FiO2 (oxygenation index, OI) showed insignificant change 3 days after air leakage. In the HFOV group, the mean duration from air-leakage to the initiation of HFOV was 10.8 ± 4.3 days. The percentages of change in OI and PaCO2 on the third day of HFOV use were 69.7 ± 56.3%, and -13.7 ± 7.1%, respectively, compared to pre-HFOV use. Two HFOV patients (50%) from the ICU survived. Twelve of 13 CV patients (92.3%) had significant deterioration in gas exchange before mortality, and expired in the course of their stay in the ICU, with a mean of 16.5 ± 3.5 days after air leakage.
Conclusion: The study suggests that HFOV may be used as a rescue ventilatory modality when conventional ventilation cannot maintain adequate gas exchange in patients with ARDS with air-leak syndrome.

並列關鍵字

High-frequency oscillatory ventilation ； acute respiratory distress syndrome ； barotrauma ； pneumothorax ； air leakage