Bhuta T, Clark R H, Henderson-Smart D J
Neonatology, NETS, POB 563, Wentworthville, Sydney, NSW, Australia, 2145.
Cochrane Database Syst Rev. 2001(1):CD002974. doi: 10.1002/14651858.CD002974.
Pulmonary disease is a major cause of mortality and morbidity in term and near term infants. Conventional ventilation (CV) has been used for many years but may lead to lung injury, require the subsequent use of more invasive treatment such as extra corporeal membrane oxygenation (ECMO), or result in death. There are some studies indicating that high frequency oscillatory ventilation (HFOV) may be more effective in these infants as compared to CV.
The objective of this review is to determine if HFOV, as compared to conventional ventilation, reduces mortality and morbidity in term or near term infants with intractable lung disease without an increase in adverse effects.
Standard search methods of the Cochrane Neonatal Review group were used. These included searches of the Oxford Database of Perinatal Trials, MEDLINE, EMBASE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, and journal hand searching by the Cochrane Collaboration.
Randomized or quasi-randomized trials comparing HFOV and CV in term or near term infants with intractable respiratory failure were included in this review.
The standard methods of the Cochrane Neonatal Review Group were used. The investigators separately extracted, assessed and coded all data for each study. Any disagreement was resolved by discussion. Data were synthesized using relative risk (RR) and risk difference (RD).
Only one trial met the inclusion criteria. This rescue trial of 81 infants showed no evidence of a reduction in mortality at 28 days [RR 0.51 (0.05, 5.43)] or in failed therapy on the assigned mode of ventilation requiring cross-over to the other mode [RR 0.73 (0.47, 1.13)]. There were no significant differences in the numbers of patients requiring extracorporeal membrane oxygenation [RR 2.05 (0.85, 4.92)], days on a ventilator, days in oxygen or days in hospital.
REVIEWER'S CONCLUSIONS: There are no data from randomized controlled trials supporting the routine use of rescue HFOV in term or near term infants with severe pulmonary dysfunction. The area is complicated by diverse pathology in such infants and by the occurrence of other interventions (surfactant, inhaled nitric oxide, inotropes). Randomized controlled trials are needed to establish the role of rescue HFOV in near term and term infants with pulmonary dysfunction before widespread use of this mode of ventilation in such infants.
肺部疾病是足月儿和近足月儿死亡和发病的主要原因。传统通气（CV）已使用多年，但可能导致肺损伤，需要随后使用更具侵入性的治疗方法，如体外膜肺氧合（ECMO），或导致死亡。有一些研究表明，与传统通气相比，高频振荡通气（HFOV）在这些婴儿中可能更有效。
本综述的目的是确定与传统通气相比，高频振荡通气是否能降低患有难治性肺部疾病的足月儿或近足月儿的死亡率和发病率，且不增加不良反应。
采用Cochrane新生儿综述小组的标准检索方法。这些方法包括检索牛津围产期试验数据库、MEDLINE、EMBASE，以及以前的综述，包括交叉参考文献、摘要、会议和研讨会记录、专家提供的信息，以及Cochrane协作网进行的期刊手工检索。
本综述纳入了比较高频振荡通气和传统通气在患有难治性呼吸衰竭的足月儿或近足月儿中的随机或半随机试验。
采用Cochrane新生儿综述小组的标准方法。研究人员分别提取、评估和编码每项研究的所有数据。任何分歧都通过讨论解决。使用相对危险度（RR）和危险度差值（RD）对数据进行综合分析。
只有一项试验符合纳入标准。这项对81名婴儿进行的挽救性试验表明，没有证据显示28天时死亡率降低[RR 0.51（0.05，5.43）]，也没有证据显示在指定通气模式下治疗失败（需要改用另一种模式）的情况减少[RR 0.73（0.47，1.13）]。在需要体外膜肺氧合的患者数量[RR 2.05（0.85，4.92）]、使用呼吸机的天数、吸氧天数或住院天数方面，没有显著差异。
没有随机对照试验的数据支持在患有严重肺功能障碍的足月儿或近足月儿中常规使用挽救性高频振荡通气。该领域因这类婴儿的病理情况多样以及其他干预措施（表面活性剂、吸入一氧化氮、强心剂）的出现而变得复杂。在这种通气模式在这类婴儿中广泛应用之前，需要进行随机对照试验来确定挽救性高频振荡通气在近足月儿和足月儿肺功能障碍中的作用。
