Synchronized intermittent mandatory ventilation with expiratory high frequency ventilation in postoper-ative children with congenital heart defect / 中国小儿急救医学

ABSTRACT

Objective Some children with congenital heart defect would get serious acute respiratory distress syndrome in ICU postoperatively,which is a tough problem.We summarized the clinical effects of synchronized intermittent mandatory ventilation (SIMV)with expiratory high frequency ventilation (HFV) for these patients in our center.Methods A total of 13 pediatric patients,with(8.15 ±4.34)months old and (8.23 ±4.01 )kg weight,used SIMV with expiratory HFV from Jan 2012 to Aug 2013.Keeping the original SIMV conditions unchanged,the expiratory oscillation amplitude were 25 to 35 Ann(A)and the oscillation frequency of 7 to 9 hertz(Hz).All patients were divided into two groups to oxygenation index(OI)30 min before HFV,high OI group(OI≤20,n ﹦5)and low OI group(OI 〈20,n ﹦8).OI ﹦MAP ×FiO2 /PaO2 .The values of OI,PaO2 /FiO2 and PaCO2 of two groups were monitored before and at 2,6,24,48 h after HFV re-spectively.Results The values of OI of all 13 patients were 19.31 ±4.42 before HFV,and then decreased to 18.77 ±5.18,16.00 ±5.22,14.77 ±6.56,and 13.92 ±6.53 respectively at 2,6,24 and 48 hours later (P 〈0.01 ).But there was no significant difference of OI in high OI group in different time points.The val-ues of PaCO2 of all 13 patients were(43.46 ±5.67)mmHg(1 mmHg ﹦0.133 kPa)before HFV,and de-creased to(38.31 ±4.21)mmHg,(37.61 ±3.36)mmHg,(34.77 ±3.81 )mmHg,and(35.92 ±2.39)mmHg respectively at 2,6,24,and 48 hours after HFV(P 〈0.01 ).Three dead patients were all in high OI group. Conclusion The mortality rate of serious acute respiratory distress syndrome with congenital heart diseases postoperatively is high.SIMV with expiratory HFV can improve oxygenation and reduce carbon dioxide,and the effect is better when OI 〈20.