High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants
High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants
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DOI：
10.1056/nejmoa012750
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发表时间：
2002-08-29
影响因子：
158.5
通讯作者：
Shoemaker, CT
中科院分区：
文献类型：
--
作者：
Courtney, SE;Durand, DJ;Shoemaker, CT
背景：早期高频振荡通气与常规同步间歇指令通气相比治疗极低出生体重儿的有效性和安全性尚未确定。多中心临床试验，以确定是否婴儿治疗早期高-在36周时，频率振荡通气比同步间歇指令通气治疗的婴儿更有可能在不需要补充氧气的情况下存活月经后期的年龄。符合条件的婴儿出生时体重为601 - 1200 g，年龄小于4小时，接受过一次表面活性剂给药，需要通气，平均气道压至少为6 cm水柱，吸入氧气分数至少为0.25。婴儿根据出生体重和产前皮质类固醇暴露进行分层，然后随机分配到高频振荡通气或同步间歇指令通气。根据旨在优化肺充气和血气值的协议管理通气。随机分配到高频振荡通气组的婴儿比分配到同步间歇强制通气组的婴儿更早成功拔管（P < 0.001）。在高频振荡通气组中，56%的婴儿在月经后36周时不需要补充氧气而存活，而接受同步间歇指令通气的婴儿则为47%（P = 0.046）。两组在颅内出血、囊性脑室周围白质软化或其他并发症的风险方面没有差异。结论：在极低出生体重儿的肺部结局方面，高频振荡通气有一个小但显著的益处，而不会增加早产其他并发症的发生。
Background The efficacy and safety of early high-frequency oscillatory ventilation as compared with conventional synchronized intermittent mandatory ventilation for the treatment of infants with very low birth weight have not been established.Methods We conducted a randomized, multicenter clinical trial to determine whether infants treated with early high-frequency oscillatory ventilation were more likely than infants treated with synchronized intermittent mandatory ventilation to be alive without requiring supplemental oxygen at 36 weeks of postmenstrual age. Eligible infants weighed 601 to 1200 g at birth, were less than four hours of age, had received one dose of surfactant, and required ventilation with a mean airway pressure of at least 6 cm of water and a fraction of inspired oxygen of at least 0.25. Infants were stratified according to birth weight and exposure to prenatal corticosteroids and then randomly assigned to high-frequency oscillatory ventilation or synchronized intermittent mandatory ventilation. Ventilation was managed according to protocols designed to optimize lung inflation and blood gas values.Results Five hundred infants were enrolled in the study. Infants randomly assigned to high-frequency oscillatory ventilation were successfully extubated earlier than infants assigned to synchronized intermittent mandatory ventilation (P < 0.001). Of infants assigned to high-frequency oscillatory ventilation, 56 percent were alive without a need for supplemental oxygen at 36 weeks of postmenstrual age, as compared with 47 percent of those receiving synchronized intermittent mandatory ventilation (P = 0.046). There was no difference between the groups in the risk of intracranial hemorrhage, cystic periventricular leukomalacia, or other complications.Conclusions There was a small but significant benefit of high-frequency oscillatory ventilation in terms of the pulmonary outcome for very-low-birth-weight infants without an increase in the occurrence of other complications of premature birth.