Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
Crit Care. 2011;15(1):R24. doi: 10.1186/cc9969. Epub 2011 Jan 17.
The purpose of the present study was to critically review the existing body of evidence on ventilation modes for infants and children up to the age of 18 years.
The PubMed and EMBASE databases were searched using the search terms 'artificial respiration', 'instrumentation', 'device', 'devices', 'mode', and 'modes'. The review included only studies comparing two ventilation modes in a randomized controlled study and reporting one of the following outcome measures: length of ventilation (LOV), oxygenation, mortality, chronic lung disease and weaning. We quantitatively pooled the results of trials where suitable.
Five trials met the inclusion criteria. They addressed six different ventilation modes in 421 children: high-frequency oscillation (HFO), pressure control (PC), pressure support (PS), volume support (VS), volume diffusive respirator (VDR) and biphasic positive airway pressure. Overall there were no significant differences in LOV and mortality or survival rate associated with the different ventilation modes. Two trials compared HFO versus conventional ventilation. In the pooled analysis, the mortality rate did not differ between these modes (odds ratio = 0.83, 95% confidence interval = 0.30 to 1.91). High-frequency ventilation (HFO and VDR) was associated with a better oxygenation after 72 hours than was conventional ventilation. One study found a significantly higher PaO2/FiO2 ratio with the use of VDR versus PC ventilation in children with burns. Weaning was studied in 182 children assigned to either a PS protocol, a VS protocol or no protocol. Most children could be weaned within 2 days and the weaning time did not significantly differ between the groups.
The literature provides scarce data for the best ventilation mode in critically ill children beyond the newborn period. There is no evidence, however, that high-frequency ventilation reduced mortality and LOV. Longer-term outcome measures such as pulmonary function, neurocognitive development, and cost-effectiveness should be considered in future studies.
本研究的目的是批判性地回顾现有的关于婴儿和 18 岁以下儿童通气模式的证据。
使用“人工呼吸”、“仪器”、“设备”、“模式”和“模式”等搜索词，在 PubMed 和 EMBASE 数据库中进行搜索。本综述仅包括比较随机对照研究中两种通气模式并报告以下一种结果测量的研究：通气时间（LOV）、氧合、死亡率、慢性肺病和撤机。我们对适合的试验进行了定量汇总。
五项试验符合纳入标准。它们涉及 421 名儿童的六种不同通气模式：高频振荡（HFO）、压力控制（PC）、压力支持（PS）、容量支持（VS）、容量扩散呼吸机（VDR）和双相正压通气。总体而言，不同通气模式与 LOV 和死亡率或生存率无显著差异。两项试验比较了 HFO 与常规通气。在汇总分析中，这些模式之间的死亡率没有差异（比值比=0.83，95%置信区间=0.30 至 1.91）。高频通气（HFO 和 VDR）在 72 小时后与常规通气相比，氧合更好。一项研究发现，在烧伤儿童中，与使用 PC 通气相比，使用 VDR 通气时 PaO2/FiO2 比值显著更高。182 名儿童被分配到 PS 方案、VS 方案或无方案，对其进行撤机研究。大多数儿童可以在 2 天内撤机，且各组之间撤机时间无显著差异。
除新生儿期外，危重病儿童最佳通气模式的文献数据很少。然而，高频通气并没有降低死亡率和 LOV。未来的研究应考虑长期结果测量，如肺功能、神经认知发育和成本效益。
