Ciuffini F, Colnaghi M, Lavizzari A, Mercadante D, Musumeci S, Mosca F
NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano.
Pediatr Med Chir. 2013 May-Jun;35(3):118-24. doi: 10.4081/pmc.2013.44.
Despite of improved survival of premature infants, the incidence of long-term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as an efficient, better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. The aim of this review is to discuss the available evidence of effectiveness and safety of HFNC in preterm newborns with respiratory distress syndrome (RDS). It is known that distending pressure generated by HFNC increases with increasing flow rate and decreasing infant size and varies according to the amount of leaks by nose and mouth. The effects of HFNC on lung mechanics, its clinical efficacy and safety are still insufficiently investigated. In conclusion, there is a growing evidence of the feasibility of HFNC as an alternative mode of NIV. However, further larger randomized trials are required, before being able to recommend HFNC in the treatment of moderate respiratory distress of preterm infants.
尽管早产儿的存活率有所提高，但长期肺部并发症的发生率仍然很高，这些并发症大多与通气诱导的肺损伤有关。无创通气（NIV）能够减少机械通气的不良影响。虽然鼻持续气道正压通气（NCPAP）是一种有效的无创通气模式，但鼻外伤并发症和鼻接口不耐受很常见。最近，高流量鼻导管（HFNC）正在成为一种高效、耐受性更好的无创通气形式，它能更好地接触婴儿面部，这可能会改善护理、喂养和亲子关系。本综述的目的是讨论HFNC在患有呼吸窘迫综合征（RDS）的早产新生儿中的有效性和安全性的现有证据。已知HFNC产生的扩张压力会随着流速增加、婴儿尺寸减小而增加，并根据口鼻漏气量而变化。HFNC对肺力学的影响、其临床疗效和安全性仍未得到充分研究。总之，越来越多的证据表明HFNC作为无创通气的替代模式是可行的。然而，在能够推荐HFNC用于治疗早产儿中度呼吸窘迫之前，还需要进一步的大型随机试验。
