Khorana Meera, Paradeevisut Hathaitip, Sangtawesin Varaporn, Kanjanapatanakul Wiboon, Chotigeat Uraiwan, Ayutthaya Jintakarn Kasemsri Na
Department of Pediatrics, Neonatology Section, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
J Med Assoc Thai. 2008 Oct;91 Suppl 3:S136-42.
To compare the rate of reintubation within 7 days after extubation and study the complications in premature infants who were randomized in the immediate postextubation period to either nsNIMV or NCPAP.
This study was conducted in the neonatal unit of Queen Sirikit National Institute of Child Health between June 1 and November 30, 2006. Intubated premature infants born at GA < or = 34 weeks or with birth weight < or = 1500 gm, ready to be extubated before 4 weeks of age were recruited. Infants were randomized to either nsNIMV or NCPAP after extubation. Non-synchronized NIMV setting was the same as ventilator setting before extubation and NCPAP pressure was set at the same mean airway pressure of pre extubation ventilator value. Extubation was performed after intravenous loading dose of aminophylline. Primary outcome measurement was reintubation within 7 days of initial extubation and the secondary outcome was possible complications such as apnea, abdominal distension, gastrointestinal (GI) perforation, necrotizing enterocolitis (NEC), sepsis and death.
A total of 70 VLBW infants were admitted to the neonatal unit during the study period. A total of 57 infants were intubated of which 48 infants were recruited for the study; 24 were in the nsNIMV group and 24 were in the NCPAP group. Infants in the nsNIMV group had mean birth weight and body weight at the start of study less than that in the NCPAP group (984.8 +/- 218 vs. 1067 +/- 214 and 1185 +/- 219 vs. 1205 +/-191, p = 0.003, 0.02). The nsNIMV group also had a higher rate of RDS and antenatal steroid used when compared to the NCPAP group (19/24 vs. 12/24 and 17/24 vs. 8/24, p = 0.03, 0.01). The nsNIMV group had fewer males than in the NCPAP group (8/24 vs. 17/24, p = 0.01). Reintubation was similar in both groups but atelectasis and sepsis were statistically significant risk factor for reintubation in NCPAP group. There were no significant differences in treatment related complications between the two groups, with respect to incidence of apnea (41.7% in nsNIMV vs. 62.5% in NCPAP), abdominal distensions (8.3% in nsNIMVvs. 16.7% in NCPAP), NEC (4.2% in nsNIMVvs. 12.5 in NCPAP), sepsis (4.2% in nsNIMVvs. 8.3% NCPAP). No GI perforation was observed in both groups.
Non-invasive mode of ventilation, both NIMV and NCPAP, for weaning ofpre-term infants from ventilator may reduce the rate of reintubation in this group. Both modes seem to be equally safe. We believe that the use of non-invasive ventilator techniques will significantly reduce neonatal morbidity in the future. Additional prospective evaluation of these approaches should be conducted in the future.
比较拔管后7天内的再次插管率，并研究在拔管后即刻随机接受无创同步间歇指令通气（nsNIMV）或鼻塞持续气道正压通气（NCPAP）的早产儿的并发症。
本研究于2006年6月1日至11月30日在诗丽吉王后国家儿童健康研究所新生儿科进行。纳入胎龄≤34周或出生体重≤1500克、准备在4周龄前拔管的插管早产儿。婴儿在拔管后随机分为nsNIMV组或NCPAP组。非同步NIMV设置与拔管前的呼吸机设置相同，NCPAP压力设置为拔管前呼吸机平均气道压相同的值。在静脉注射负荷剂量氨茶碱后进行拔管。主要结局指标是初次拔管后7天内的再次插管情况，次要结局是可能的并发症，如呼吸暂停、腹胀、胃肠道穿孔、坏死性小肠结肠炎（NEC）、败血症和死亡。
在研究期间，共有70例极低出生体重儿入住新生儿科。共有57例婴儿插管，其中48例婴儿被纳入研究；24例在nsNIMV组，24例在NCPAP组。nsNIMV组婴儿在研究开始时的平均出生体重和体重低于NCPAP组（984.8±218与1067±214，以及1185±219与1205±191，p = 0.003，0.02）。与NCPAP组相比，nsNIMV组呼吸窘迫综合征（RDS）发生率和产前使用类固醇的比例也更高（19/24与12/24，以及17/24与8/24，p = 0.03，0.01）。nsNIMV组男性少于NCPAP组（8/24与17/24，p = 0.01）。两组再次插管情况相似，但肺不张和败血症是NCPAP组再次插管的统计学显著危险因素。两组在治疗相关并发症方面无显著差异，呼吸暂停发生率（nsNIMV组为41.7%，NCPAP组为62.5%）、腹胀发生率（nsNIMV组为8.3%，NCPAP组为16.7%）、NEC发生率（nsNIMV组为4.2%，NCPAP组为12.5%）、败血症发生率（nsNIMV组为4.2%，NCPAP组为8.3%）。两组均未观察到胃肠道穿孔。
对于早产儿撤机，无创通气模式，即NIMV和NCPAP，可能会降低该组的再次插管率。两种模式似乎同样安全。我们相信，无创通气技术的使用将在未来显著降低新生儿发病率。未来应进一步对这些方法进行前瞻性评估。
