Open the lung with high-frequency oscillation ventilation or conventional mechanical ventilation It may not matter! 英文参考文献.docVIP

Fanelli and Mehta Critical Care 2010,14:1010 /content/14/6/1010 COMMENTARY Open the lung with high-frequency oscillation ventilation or conventional mechanical ventilation? It may not matter! Vito Fanelli and Sangeeta Mehta* 1,2 2,3 See related research by Krebs et al., /content/14/5/R183 end-expiratory pressure (PEEP) CMV. Using two animal models of lung injury (saline-lavage and lipopolysac- charide (LPS)), they randomized rats to three ventilation strategies: CMV and low PEEP, CMV and high PEEP (pursuing an ‘open lung’ strategy), and HFOV. In both CMV groups protective ventilation was ensured by limiting tidal volume to 6 ml/kg. Compared to the low PEEP group, the open lung approach, whether applied with CMV or HFOV, was able to reduce VILI, as demon- strated by improvements in the respiratory system elastance, oxygenation, and histological lung injury score, as well as reduced expression of in? ammatory cytokines. Moreover, comparing rats randomized to the two open lung approaches, HFOV resulted in better oxygenation than CMV with high PEEP, but elastance, lung injury and cytokine levels did not di? er between the two groups. Pivotal animal studies have eloquently demonstrated the deleterious e? ects of mechanical ventilation in initiating or perpetuating lung injury [2], and these studies have provided invaluable input for human studies, culminating in the ARDSnet trial showing that lung- protective tidal volume limitation reduces acute respira- tory distress syndrome (ARDS)-associated mortality [3]. In addition to tidal alveolar overstretching, tidal alveolar recruitment/derecruitment has also been implicated in VILI [2]. An ‘open lung’ approach [4], applying higher Abstract The‘open lung’approach has been proposed as a reasonable ventilation stra