Department of Pediatrics, Jackson Memorial Hospital, University of Miami, Miami, Florida 33101, USA.
Pediatr Res. 2011 Jan;69(1):84-9. doi: 10.1203/PDR.0b013e3181ff6770.
Nasal ventilation is increasingly used to reduce invasive ventilation in preterm infants. The effects of nasal ventilation and the advantages of synchronized nasal ventilation have not been fully evaluated. The objective was to compare the short-term effects of nasal intermittent mandatory ventilation (NIMV) and synchronized NIMV (S-NIMV) with nasal continuous positive airway pressure (NCPAP) on ventilation, gas exchange, and infant-ventilator interaction. Sixteen clinically stable preterm infants requiring NCPAP (GA, 27.6 ± 2.3 wk; birthweight (BW), 993 ± 248 g; and age, 15 ± 14 d) were exposed to NCPAP, NIMV at 20/min, NIMV at 40/min, S-NIMV at 20/min, and S-NIMV at 40/min for 1 h each (Infant-Star ventilator), in random order. Tidal volume, minute ventilation, and gas exchange did not differ significantly between NCPAP, NIMV, and S-NIMV. Inspiratory effort decreased during S-NIMV compared with NCPAP and NIMV, whereas inspiratory effort during NIMV did not differ from NCPAP. Active expiratory effort and expiratory duration increased during NIMV. Chest wall distortion, apnea and hypoxemia spells, abdominal girth, and comfort did not differ. In conclusion, there were no short-term benefits on ventilation and gas exchange of nasal ventilation compared with NCPAP in clinically stable preterm infants. However, synchronized nasal ventilation reduced breathing effort and resulted in better infant-ventilator interaction than nonsynchronized nasal ventilation.
经鼻通气越来越多地用于减少早产儿的有创通气。经鼻通气的效果和同步经鼻通气的优点尚未得到充分评估。目的是比较经鼻间歇强制通气（NIMV）和同步经鼻间歇强制通气（S-NIMV）与经鼻持续气道正压通气（NCPAP）对通气、气体交换和婴儿-呼吸机相互作用的短期影响。16 名临床稳定的早产儿需要 NCPAP（GA，27.6 ± 2.3 周；出生体重（BW），993 ± 248 g；年龄，15 ± 14 天），随机接受 NCPAP、20/min 的 NIMV、40/min 的 NIMV、20/min 的 S-NIMV 和 40/min 的 S-NIMV 各 1 小时（婴儿之星呼吸机）。潮气量、分钟通气量和气体交换在 NCPAP、NIMV 和 S-NIMV 之间没有显著差异。与 NCPAP 和 NIMV 相比，S-NIMV 期间吸气努力降低，而 NIMV 期间的吸气努力与 NCPAP 没有差异。NIMV 期间主动呼气努力和呼气时间增加。胸壁变形、呼吸暂停和低氧血症发作、腹部周长和舒适度没有差异。总之，与 NCPAP 相比，在临床稳定的早产儿中，经鼻通气在通气和气体交换方面没有短期益处。然而，与非同步经鼻通气相比，同步经鼻通气可降低呼吸努力，并可改善婴儿-呼吸机的相互作用。
