Davis P G, Henderson-Smart D J
Division of Paediatrics, Royal Women's Hospital, 132 Grattan St, Melbourne, Victoria, Australia, 3053.
Cochrane Database Syst Rev. 2000(2):CD000143. doi: 10.1002/14651858.CD000143.
Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population.
In preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), does management with nasal continuous positive airways pressure (NCPAP) lead to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen?
Searches were made of the Oxford Database of Perinatal Trials, Medline, previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language and expert informant searches in the Japanese language by Prof. Ogawa.
All trials utilising random or quasi-random patient allocation, in which NCPAP (delivered by any method) was compared with headbox oxygen for post-extubation care were included. Methodological quality was assessed independently by the two authors.
Data were extracted independently by the two authors. Prespecified subgroup analysis to determine the impact of different levels of NCPAP, differences in duration of IPPV and use of aminophylline were also performed using the same package.
Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support. A reduction in the incidence of chronic lung disease at 28 days of age is also seen in the group extubated to NCPAP.
nasal CPAP is effective in preventing failure of extubation and reducing oxygen use at 28 days of life in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the patient gestational age and weight groups in whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.
经气管插管进行间歇正压通气一段时间后拔管的早产儿，有因呼吸暂停、呼吸性酸中毒和低氧血症而发生呼吸衰竭的风险。经鼻持续气道正压通气似乎能稳定上呼吸道、改善肺功能并减少呼吸暂停，因此可能在促进该人群拔管方面发挥作用。
在经一段时间间歇正压通气（IPPV）后拔除气管插管的早产儿中，与直接拔管至头罩吸氧相比，经鼻持续气道正压通气（NCPAP）管理是否会使无需额外通气支持的比例增加？
检索了牛津围产期试验数据库、Medline、包括交叉参考文献的既往综述、会议和研讨会论文摘要、专家咨询、主要为英文的期刊手工检索以及小川教授进行的日语专家咨询检索。
纳入所有采用随机或半随机患者分配的试验，其中将NCPAP（通过任何方法提供）与头罩吸氧用于拔管后护理进行比较。两位作者独立评估方法学质量。
两位作者独立提取数据。还使用同一软件包进行了预定的亚组分析，以确定不同水平的NCPAP、IPPV持续时间差异和氨茶碱使用的影响。
对IPPV后拔管的早产儿应用经鼻持续气道正压通气（CPAP），可降低不良临床事件（呼吸暂停、呼吸性酸中毒和吸氧需求增加）的发生率，表明需要额外通气支持。拔管至NCPAP组在28日龄时慢性肺病的发生率也有所降低。
经鼻持续气道正压通气（CPAP）可有效预防拔管失败，并减少经气管插管和IPPV一段时间后的早产儿在28日龄时的吸氧需求。研究意义：需要进一步明确这些结果适用的患者胎龄和体重组。NCPAP的最佳水平以及给药方法仍有待确定。
