Neurally Adjusted Ventilatory Assist in Preterm Infants With Established or Evolving Bronchopulmonary Dysplasia on High-Intensity Mechanical Ventilatory Support: A Single-Center Experience
Neurally Adjusted Ventilatory Assist in Preterm Infants With Established or Evolving Bronchopulmonary Dysplasia on High-Intensity Mechanical Ventilatory Support: A Single-Center Experience
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对已患有或正在发展的支气管肺发育不良的早产儿进行高强度机械通气支持的神经调节通气辅助：单中心经验
DOI：
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发表时间：
2016
影响因子：
4.1
通讯作者：
J. Choi
中科院分区：
文献类型：
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作者：
Y. Jung;Han;Juyoung Lee;S. Shin;E. Kim;J. Choi
目的：本研究的目的是报告在一个中心，需要高水平机械通气支持的支气管肺发育不良早产儿从同步间歇指令通气过渡到神经调节通气辅助，可能改善呼吸机变量。设计：回顾性研究。设置：新生儿ICU。患者：29例早产儿，中位胎龄为25.4周（范围：23.4-30.3周），中位出生体重为680 g（范围：370- 1，230 g），使用机械呼吸机支持超过4周，在转换为神经调节呼吸辅助之前，常规机械通气期间呼吸严重程度评分大于4。干预措施：比较常规通气期间和改为神经调节呼吸辅助后不同时间间隔的呼吸变量、呼吸功和血气值。测量和主要结果：在神经调节的呼吸辅助前1小时和转换为神经调节的呼吸辅助后1、4、12和24小时获得各种呼吸变量和其他测量值。在神经调节的吸气辅助期间，（20.12 ± 2.93 vs 14.15 ± 3.55 cm H2O; p < 0.05），平均气道压（11.15 ± 1.29 vs 9.57 ± 1.27 cm H2O; p < 0.05），呼吸功（0.86 ± 0.22 vs 0.46 ± 0.12 J/L; p < 0.05）显著降低，血气值显著改善。与常规通气支持相比，神经调节呼吸辅助期间观察到FIO 2显著降低，氧饱和度改善。RSS值在神经调节的呼吸辅助过程中降低并持续（4.85 ± 1.63 vs 3.21 ± 1.01; p < 0.001）。结论：从同步间歇指令通气到神经调节呼吸辅助通气的转变与单个中心的支气管肺发育不良婴儿的呼吸机变量、氧饱和度和血气值的改善相关。这项研究表明，可能的临床效用的神经调节辅助脱机模式的支气管肺发育不良患者在新生儿重症监护室。
Objectives: The aim of the present study was to report possible improvements in ventilator variables associated with a transition from synchronized intermittent mandatory ventilation to neurally adjusted ventilatory assist in preterm infants with bronchopulmonary dysplasia who required a high level of mechanical ventilatory support in a single center. Design: Retrospective study. Setting: Neonatal ICU. Patients: Twenty-nine preterm infants with a median gestational age of 25.4 weeks (range, 23.4–30.3 wk) and a median birth weight of 680 g (range, 370–1,230 g) and who were supported with a mechanical ventilator for more than 4 weeks and had a respiratory severity score greater than four during conventional mechanical ventilation prior to conversion to neurally adjusted ventilatory assist. Interventions: Comparison of ventilatory variables, work of breathing, and blood gas values during conventional ventilation and at various time intervals after the change to neurally adjusted ventilatory assist. Measurements and Main Results: The values of various ventilatory variables and other measurements were obtained 1 hour before neurally adjusted ventilatory assist and 1, 4, 12, and 24 hours after conversion to neurally adjusted ventilatory assist. During neurally adjusted ventilatory assist, the peak inspiratory pressure (20.12 ± 2.93 vs 14.15 ± 3.55 cm H2O; p < 0.05), mean airway pressure (11.15 ± 1.29 vs 9.57 ± 1.27 cm H2O; p < 0.05), and work of breathing (0.86 ± 0.22 vs 0.46 ± 0.12 J/L; p < 0.05) were significantly decreased, and the blood gas values were significantly improved. Significantly lower FIO2 and improved oxygen saturation were observed during neurally adjusted ventilatory assist compared with conventional ventilation support. The RSS values decreased and sustained during neurally adjusted ventilatory assist (4.85 ± 1.63 vs 3.21 ± 1.01; p < 0.001). Conclusions: The transition from synchronized intermittent mandatory ventilation to neurally adjusted ventilatory assist ventilation was associated with improvements in ventilator variables, oxygen saturation, and blood gas values in infants with bronchopulmonary dysplasia in a single center. This study suggests the possible clinical utility of neurally adjusted ventilatory assist as a weaning modality for bronchopulmonary dysplasia patients in the neonatal ICU.