高頻振盪式呼吸器於成人急性呼吸窘迫症的角色

本呼吸器是急性呼吸窘迫症主要的治療方式，但呼吸器的使用可能造成所謂“呼吸器伴隨的肺傷害”，這些機轉包含：肺泡過度擴張（容積傷害）、反覆肺泡開關（塌陷傷害）、全身性發炎反應（生物傷害）以及氧氣毒性。高頻振盪式呼吸器理論上可達到肺保護的目的:高於傳統呼吸器更高的平均氣道壓力，以避免塌陷傷害；較低的潮氣容積以避免容積傷害。目前，高頻振盪式呼吸器用在成人急性呼吸窘迫症的研究顯示，對於使用傳統呼吸器失敗者，可以嘗試去改善氣體交換，然而存活率的改善仍需進一步研究，因此不建議早期且常規來使用。未來需要更大型的臨床研究，來比較高頻振盪式呼吸器與傳統呼吸器使用最佳的肺保護性策略時，兩者對於病患存活率是否有差異？

關鍵字

急性呼吸窘迫症；成人；呼吸器伴隨的肺傷害；高頻振盪式呼吸器

並列摘要

Mechanical ventilation is the major therapy for patients with acute respiratory distress syndrome (ARDS). However, mechanical ventilation may further damage the injured lung-a phenomenon known as ventilator associated lung injury (VALI). These mechanisms include alveolar overdistention (volutrauma), repetitive recruitment and derecruitment (atelectrauma), mechanotransduction leading to a systemic inflammatory response (biotrauma), and oxygen toxicity. High-frequency oscillatory ventilation (HFOV) theoretically achieves lung protective ventilation goals. During HFOV, a mean airway pressure, usually higher than that used in conventional ventilation, is applied to achieve and maintain lung recruitment. Additionally, HFOV delivers small tidal volumes at extreme quick rate, thus avoiding large alveolar pressures and volume excursions typical of conventional ventilation. Current studies support HFOV use in adult ARDS patients to attempt to improve gas exchange in failing conventional ventilation. However, survival outcomes need to test in larger powered trials. Early routine use of HFOV for adults with ARDS therefore cannot be recommended. Further larger clinical studies are needed to compare the effects on patient outcome of HFOV compared to the most protective use of conventional modes in adult acute respiratory distress syndrome.

並列關鍵字

Acute respiratory distress syndrome ； Adult ； Ventilator associated lung injury ； High-frequency oscillatory ventilation

國際替代計量

高頻振盪式呼吸器於成人急性呼吸窘迫症的角色

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