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首页> 外文期刊>Southern African Journal of Critical Care >High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit in an academic hospital in Johannesburg, South Africa
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High-frequency oscillatory ventilation in a tertiary paediatric intensive care unit in an academic hospital in Johannesburg, South Africa

机译：南非约翰内斯堡一家大学医院的三级儿科重症监护病房的高频振荡通气

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BACKGROUND. High-frequency oscillatory ventilation (HFOV) remains an option for the management of critically ill children when conventional mechanical ventilation fails. However, its use is not widespread, and there is wide variability reported with respect to how it is used. OBJECTIVES. To describe the frequency, indications, settings and outcomes of HFOV use among paediatric patients with a primary respiratory disorder admitted to a tertiary paediatric intensive care unit (PICU). METHODS. The study was a 2-year, single-centre, retrospective chart review. RESULTS. Thirty-four (32.7%) patients were managed with HFOV in the PICU during the study period. Thirty-three of the 34 patients had paediatric acute respiratory distress syndrome. Indications for HFOV were inadequate oxygenation in 17 patients (50%), and refractory respiratory acidosis in 15 patients (44.1%) (2 patients did not fit into either category). Approaches to the setting of HFOV varied considerably, particularly with respect to initial pressure around the airways. HFOV was effective at improving both oxygenation, with a median (interquartile range (IQR)) decrease in oxygenation index of 6.34 (5.0 - 9.5), and ventilation with a the median decrease in PaCO2 of 67.6 (46.2 - 105.7) mmHg after 24 hours. Overall mortality was 29.4% in the HFOV group, which is consistent with other studies. CONCLUSION. HFOV remains an effective rescue ventilatory strategy, which resulted in rapid and sustained improvement in gas exchange in patients with severe hypoxaemia and/or severe respiratory acidosis, particularly in the absence of extracorporeal support. However, the variability in practice and the adverse effects described highlight the need for future high-quality randomised controlled trials to allow for development of meaningful guidelines to optimise HFOV use.
机译：背景。当常规机械通气失败时，高频振荡通气（HFOV）仍然是重症儿童管理的一种选择。然而，它的使用并不广泛，并且关于其使用方式报道了广泛的可变性。目标描述三级重症监护病房（PICU）的原发性呼吸系统疾病的小儿患者使用HFOV的频率，适应症，设置和结果。方法。这项研究是一项为期2年的单中心回顾性图表审查。结果。在研究期间，有34例（32.7％）患者在PICU中接受了HFOV治疗。 34例患者中有33例患有小儿急性呼吸窘迫综合征。 HFOV的适应症是17例患者（50％）的氧合不足，15例患者（44.1％）的难治性呼吸性酸中毒（2例均不属于这两个类别）。设置HFOV的方法变化很大，尤其是在气道周围的初始压力方面。 HFOV可有效改善氧合，24小时后氧合指数中位数（四分位间距（IQR））降低6.34（5.0-9.5），通气时PaCO2中位数降低67.6（46.2-105.7）mmHg 。 HFOV组的总死亡率为29.4％，与其他研究一致。结论。 HFOV仍然是一种有效的抢救性通气策略，在患有严重低氧血症和/或严重呼吸性酸中毒的患者中，尤其是在没有体外支持的情况下，导致气体交换的快速持续改善。但是，实践中的可变性和所描述的不利影响突显了对未来高质量随机对照试验的需求，以允许制定有意义的指南来优化HFOV的使用。

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