Sharma Atul, Greenough Anne
King's College London, MRC-Asthma Centre, Division of Asthma, Allergy and Lung Biology, London, UK.
Acta Paediatr. 2007 Aug;96(8):1115-7. doi: 10.1111/j.1651-2227.2007.00388.x. Epub 2007 Jun 21.
To survey current practice regarding neonatal respiratory support strategies to determine whether it reflected evidence from randomised trials.
A questionnaire (in Supplementary Material online) survey of all U.K. neonatal units was undertaken to determine what modes of ventilation, types of endotracheal tube, lung function monitoring and oxygen saturation levels were used.
There was an 80% response rate. Most (73%) units used in prematurely born infants (in the first 24 h) the intermittent positive pressure ventilation, and other respiratory modes included: CPAP (2%), triggered ventilation with or without volume guarantee (22%) and high frequency oscillation (2%). Only 15% of units used assist control mode for weaning; the preferred weaning mode was synchronous intermittent mandatory ventilation (73%). Few units used shouldered endotracheal tubes (3%) or lung function measurements (25%) to aid choice of ventilator settings. Oxygen saturation levels from 80% to 98% were used, levels greater or equal to 95% were used by 11% of units for infants with acute respiratory disease but by 34% of units for BPD infants (p < 0.001).
Many practitioners do not base their choice of neonatal respiratory support strategies on the results of large randomised trials; more effective methods are required to ensure evidence-based practice.
调查目前新生儿呼吸支持策略的应用情况，以确定其是否反映了随机试验的证据。
对英国所有新生儿病房进行问卷调查（问卷见在线补充材料），以确定所使用的通气模式、气管内导管类型、肺功能监测方法及氧饱和度水平。
回复率为80%。大多数（73%）病房在早产儿出生后24小时内使用间歇正压通气，其他呼吸模式包括：持续气道正压通气（2%）、有或无容量保证的触发通气（22%）和高频振荡通气（2%）。只有15%的病房在撤机时使用辅助控制模式；首选的撤机模式是同步间歇指令通气（73%）。很少有病房使用带肩部的气管内导管（3%）或肺功能测量（25%）来辅助选择通气设置。氧饱和度水平设定在80%至98%之间，11%的病房对急性呼吸疾病患儿采用95%及以上的氧饱和度水平，但对支气管肺发育不良患儿采用该水平的病房占34%（p<0.001）。
许多从业者在选择新生儿呼吸支持策略时并非基于大型随机试验的结果；需要更有效的方法来确保循证实践。
