• 作者：J.A. Garcí ; a-Hern&#225 ; ndez^a ; ^{garcier@gmail.com} ; A. V&#225 ; zquez Florido^a ; A.I. Martí ; nez-Ló ; pez^b ; J.M. Praena-Fern&#225 ; ndez^c ; A. Cayuela-Domí ; nguez^c ; J. Cano-Franco^a ; M. Loscertales-Abril^a
• 关键词：Sí ; ndrome de distré ; s respiratorio agudo ; Ventilació ; n de alta frecuencia oscilatoria ; Ventilació ; n protectora pulmonar
• 刊名：Anales de Pediatr¨ªa
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：78
• 期：2
• 页码：94-103
• 全文大小：402 K

Introduction

The high frequency oscillatory ventilation (HFOV) may reduce cardiac output. The haemodynamics were analysed and predictors of mortality identified.

Patients and methods

A total of 48 children with respiratory failure undergoing HFOV between January 2003 and December 2010 were included. The study design was prospective, observational, and descriptive. Inclusion criteria were based on the existence of hypoxemia. The variables studied were: arterial and central venous pressure, arterial pH, venous saturation and oxygen extraction ratio, with determinations performed prior to HFOV, during, and before turning to conventional ventilation. Prognostic factors were identified by bivariate analysis and a predictive model of mortality was developed.

Results

The mean age was 21 [4 to 72] months. On admission, PRISM scales and Murray were 33 and 2.8, PaO₂/FiO₂ of 61 and oxygenation index of 35. After HFOV an increase in pH (P<.001), mean arterial pressure (P<.001) and venous saturation, and decreased venous pressure and O₂ extraction (P<.001), was obtained. The prognostic factors of mortality at 24 hours after starting HFOV were: FiO₂, PaO₂/FiO₂, oxygenation index, shunt, pH, central venous pressure and mean arterial pressure, venous saturation, and O₂ extraction. The model developed at 12 hours, consisting of EtO₂ and SvcO₂ was able to predict death with a probability of 92.3 % .

Conclusions

HFOV improves haemodynamics. The model at 12 hours is the best predictor of death.