부산대학교 도서관

Introduction In acute respiratory distress syndrome (ARDS), combined high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) improves gas exchange compared with conventional mechanical ventilation (CMV). We evaluated the effect of HFO-TGI on PaO.sub.2/fractional inspired O.sub.2 (FiO.sub.2) and PaCO.sub.2, systemic hemodynamics, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) in patients with traumatic brain injury (TBI) and concurrent severe ARDS. Methods We studied 13 TBI/ARDS patients requiring anesthesia, hyperosmolar therapy, and ventilation with moderate-to-high CMV-tidal volumes for ICP control. Patients had PaO.sub.2/FiO.sub.2 12 hours. Arterial/central-venous blood gases, hemodynamics, and ICP were recorded before, during (every 4 hours), and after HFO-TGI, and were analyzed by using repeated measures analysis of variance. Respiratory mechanics were assessed before and after HFO-TGI. Results Each patient received three to four HFO-TGI sessions (total sessions, n = 43). Pre-HFO-TGI PaO.sub.2/FiO.sub.2 (mean [+ or -] standard deviation (SD): 83.2 [+ or -] 15.5 mm Hg) increased on average by approximately 130% to163% during HFO-TGI (P < 0.01) and remained improved by approximately 73% after HFO-TGI (P < 0.01). Pre-HFO-TGI CMV plateau pressure (30.4 [+ or -] 4.5 cm H.sub.2O) and respiratory compliance (37.8 [+ or -] 9.2 ml/cm H.sub.2O), respectively, improved on average by approximately 7.5% and 20% after HFO-TGI (P < 0.01 for both). During HFO-TGI, systemic hemodynamics remained unchanged. Transient improvements were observed after 4 hours of HFO-TGI versus pre-HFO-TGI CMV in PaCO.sub.2 (37.7 [+ or -] 9.9 versus 41.2 [+ or -] 10.8 mm Hg; P < 0.01), ICP (17.2 [+ or -] 5.4 versus 19.7 [+ or -] 5.9 mm Hg; P < 0.05), and CPP (77.2 [+ or -] 14.6 versus 71.9 [+ or -] 14.8 mm Hg; P < 0.05). Conclusions In TBI/ARDS patients, HFO-TGI may improve oxygenation and respiratory mechanics, without adversely affecting PaCO.sub.2, hemodynamics, or ICP. These findings support the use of HFO-TGI as a rescue ventilatory strategy in patients with severe TBI and imminent oxygenation failure due to severe ARDS.
Author(s): Charikleia S Vrettou[sup.1] , Spyros G Zakynthinos[sup.1] , Sotirios Malachias[sup.1] and Spyros D Mentzelopoulos[sup.1] Introduction The management of patients with traumatic brain injury (TBI) becomes challenging when complicated by [...]