Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Denmark Hill, London SE5 9RS, UK.
Eur J Pediatr. 2012 Nov;171(11):1633-8. doi: 10.1007/s00431-012-1784-7. Epub 2012 Jul 22.
Infants born at term requiring mechanical ventilation suffer significant mortality and morbidity, yet few studies have tried to identify the optimum respiratory support for such infants. We, therefore, hypothesised that practice would vary, particularly between different levels of neonatal care provision. The lead clinicians of all 212 UK neonatal units were asked to complete an electronic web-based survey regarding respiratory support practices for term-born infants. Survey questions included the level of neonatal care provided, number of term-born infants ventilated per annum, initial and rescue ventilation modes and whether surfactant or inhaled nitric oxide (NO) were used. The overall response rate was 82 %. A greater proportion of neonatal intensive care units (NICUs) compared to local neonatal units (LNUs) stated that they used volume-targeting, particularly for infants with RDS (p = 0.0006) or congenital pneumonia (p = 0.0005). High-frequency oscillatory ventilation was stated as initial mode by a greater proportion of NICUs compared to LNUs and special care units (SCUs), particularly for respiratory distress syndrome (p < 0.0001) or persistent pulmonary hypertension of the newborn (p < 0.001). Continuous mandatory ventilation was stated to be the rescue mode by a greater proportion of LNUs/SCUs compared to NICUs (p < 0.0001). Surfactant was stated to be most commonly given for respiratory distress syndrome (79 % of units) and MAS (61 % of units); surfactant use was lowest in SCUs (p < 0.0001); inhaled NO was infrequently used by LNUs and SCUs. Conclusions There was considerable variation in respiratory support practices for term-born infants, particularly between different levels of neonatal care provision.
足月出生需要机械通气的婴儿死亡率和发病率都很高，但很少有研究试图确定此类婴儿的最佳呼吸支持方法。因此，我们假设实践会有所不同，尤其是在不同级别的新生儿护理提供之间。要求所有 212 家英国新生儿单位的首席临床医生完成一份关于足月出生婴儿呼吸支持实践的电子网络调查。调查问题包括提供的新生儿护理水平、每年需要通气的足月出生婴儿数量、初始和抢救通气模式以及是否使用表面活性剂或吸入性一氧化氮（NO）。总的回复率为 82%。与当地新生儿单位（LNUs）相比，新生儿重症监护病房（NICUs）更倾向于使用容量目标通气，尤其是对于患有 RDS（p = 0.0006）或先天性肺炎（p = 0.0005）的婴儿。与 LNUs 和特殊护理单位（SCUs）相比，NICUs 更倾向于将高频振荡通气作为初始模式，特别是对于呼吸窘迫综合征（p < 0.0001）或新生儿持续性肺动脉高压（p < 0.001）。与 NICUs 相比，LNUs/SCUs 更倾向于将持续强制通气作为抢救模式（p < 0.0001）。大多数单位（79%）表示表面活性剂最常用于呼吸窘迫综合征，61%的单位用于 MAS；SCUs 中表面活性剂的使用最低（p < 0.0001）；LNUs 和 SCUs 很少使用吸入性 NO。结论 足月出生婴儿的呼吸支持实践存在很大差异，尤其是在不同级别的新生儿护理提供之间。
