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Árangur meðferðar með hátíðniöndunarvél hjá nýburum með alvarlega öndunarbilun

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Authors
Sólrún Björk Rúnarsdóttir
Atli Dagbjartsson
Gestur Pálsson
Hörður Bergsteinsson
Sveinn Kjartansson
þórður Þórkelsson
Issue Date
2005-11-01

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Other Titles
The efficacy of high frequency ventilation in severe neonatal respiratory failure
Citation
Læknablaðið 2005, 91(11):813-9
Abstract
OBJECTIVE: To evaluate the efficacy of high frequency ventilation (HFV) in infants failing conventional ventilator therapy at our institution. STUDY GROUP AND METHODS: Medical records of all infants managed on HFV after having failed conventional ventilator management from 1994-2004 were reviewed. Ventilatory settings, blood gases and pH just prior to starting HFV, and two and four hours after starting HFV were recorded. RESULTS: Sixty one infants met the study criteria. At two hours of HFV there was a significant improvement in oxygenation (Alveolar to arterial oxygen tension difference), ventilation and acid-base balance. These values were not significantly different between two and four hours of HFV. There was no significant difference in oxygenation between survivors (n=41) and non-survivors (n=20) prior to HFV, but after two hours of HFV the survivors had significant improvement in oxygenation. Thirty one of the survivors had improved oxygenation at two and four hours of HFV, but only eight of the nonsurvivors (p=0.03). CONCLUSIONS: HFV results in significant improvements in oxygenation, ventilation and acid-base balance in most infants failing conventional ventilatory management. The immediate response to HFV may be a predictor of survival in infants with severe hypoxic respiratory failure.
Tilgangur rannsóknar: Kanna árangur meðferðar með hátíðniöndunarvél (HTÖ) hjá nýburum með alvarlega öndunarbilun. Tilfelli og aðferðir: Afturvirk rannsókn sem tók til tímabilsins 1994 til 2004. Klínískar upplýsingar voru fengnar úr sjúkraskrám barnanna. Í rannsókninni voru eingöngu börn þar sem meðferð með hefðbundinni öndunarvél hafði ekki borið tilætlaðan árangur. Blóðildun, loftun og sýru-basavægi voru metin rétt áður en HTÖ meðferðin var hafin, tveimur og fjórum klukkustundum eftir að hún hófst. Niðurstöður: Sextíu og einn nýburi uppfyllti þátttökuskilyrði. Eftir tvær klukkustundir á HTÖ var blóðildun (A-a pO2 mismunur), loftun og sýru- og basavægi marktækt betra en fyrir meðferð með HTÖ. Ekki reyndist marktækur munur á mæl­ingunum við tvær og fjórar klukkustundir. Fyrir meðferð með HTÖ var blóðildun þeirra sem lifðu (41 barn) og þeirra sem létust (20 börn) svipuð, en eftir tvær klukkustundir á HTÖ var hópurinn sem lifði með marktækt betri blóðildun. Þrjátíu og eitt barn af þeim sem lifðu höfðu betri blóðildun eftir að HTÖ meðferð var hafin, en aðeins átta af þeim sem létust (p=0,03). Ályktun: Meðferð með HTÖ bætir blóðildun, loftun og sýru-basavægi flestra nýbura með alvarlegan lungnasjúkdóm þegar meðferð með hefðbundinni öndunarvél ber ekki tilætlaðan árangur. Svörun við meðferð með HTÖ hefur visst forspárgildi um horfur nýbura með alvarlega öndunarbilun.
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