Late outcomes of a randomized trial of high-frequency oscillation in neonates.
Late outcomes of a randomized trial of high-frequency oscillation in neonates.
复制标题
新生儿高频振荡随机试验的最新结果。
DOI：
10.1097/01.aoa.0000460415.48906.43
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
A. Greenough
中科院分区：
文献类型：
--
作者：
S. Zivanovic;J. Peacock;Mireia Alcazar;J. Lo;A. Lunt;N. Marlow;S. Calvert;A. Greenough
背景
一项涉及新生儿的观察性研究的结果表明，与常规通气相比，高频振荡通气（HFOV）与随访时的上级小气道功能相关。需要随机试验的数据来证实这一发现。
方法
我们研究了319名在妊娠29周前出生的青少年，他们参加了一项多中心随机试验，比较了HFOV与出生后立即进行的常规通气。该试验涉及797名新生儿，其中592名存活出院。我们比较了随机分配到HFOV组的青少年的随访数据与随机分配到常规通气组的青少年的随访数据，包括肺功能和呼吸健康、健康相关生活质量和功能状态，使用参与者11至14岁时完成的问卷进行评估。主要结果是用力呼气流量为呼气肺活量的75%（FEF 75）。
结果
HFOV组在小气道功能测试中具有上级结果（FEF 75的z评分，HFOV组为-0.97，常规治疗组为-1.19;校正差异为0.23 [95%置信区间为0.02 ~ 0.45]）。HFOV在其他几项呼吸功能测量中存在显著差异，包括1秒用力呼气量、用力肺活量、呼气峰流量、弥散量和脉冲血流测量结果。与常规治疗组相比，HFOV组在评估的8个学校科目中有3个科目的教师评分显着较高，但在功能结果方面没有其他显着差异。
结论
在一项涉及极早产儿的随机试验中，与接受常规通气的儿童相比，接受HFOV的儿童在11至14岁时的肺功能上级，没有证据表明功能结局更差。（由国家卫生研究所卫生技术评估方案和其他机构资助）。
BACKGROUND
Results from an observational study involving neonates suggested that high-frequency oscillatory ventilation (HFOV), as compared with conventional ventilation, was associated with superior small-airway function at follow-up. Data from randomized trials are needed to confirm this finding.
METHODS
We studied 319 adolescents who had been born before 29 weeks of gestation and had been enrolled in a multicenter, randomized trial that compared HFOV with conventional ventilation immediately after birth. The trial involved 797 neonates, of whom 592 survived to hospital discharge. We compared follow-up data from adolescents who had been randomly assigned to HFOV with follow-up data from those who had been randomly assigned to conventional ventilation, with respect to lung function and respiratory health, health-related quality of life, and functional status, as assessed with the use of questionnaires completed when the participants were 11 to 14 years of age. The primary outcome was forced expiratory flow at 75% of the expired vital capacity (FEF75).
RESULTS
The HFOV group had superior results on a test of small-airway function (z score for FEF75, -0.97 with HFOV vs. -1.19 with conventional therapy; adjusted difference, 0.23 [95% confidence interval, 0.02 to 0.45]). There were significant differences in favor of HFOV in several other measures of respiratory function, including forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow, diffusing capacity, and impulse-oscillometric findings. As compared with the conventional-therapy group, the HFOV group had significantly higher ratings from teachers in three of eight school subjects assessed, but there were no other significant differences in functional outcomes.
CONCLUSIONS
In a randomized trial involving children who had been born extremely prematurely, those who had undergone HFOV, as compared with those who had received conventional ventilation, had superior lung function at 11 to 14 years of age, with no evidence of poorer functional outcomes. (Funded by the National Institute for Health Research Health Technology Assessment Programme and others.).