Stefanescu B M, Frewan N, Slaughter J C, O'Shea T M
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Pediatrics, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
J Perinatol. 2015 Jun;35(6):419-23. doi: 10.1038/jp.2014.228. Epub 2015 Jan 8.
Compared with pressure-controlled ventilation (PCV), volume-targeted ventilation is associated with decreased neonatal complications, including the combined outcome of death or bronchopulmonary dysplasia. However, little is known about its effect on neurodevelopmental outcome. We evaluated the hypothesis that as compared with PCV, volume-targeted ventilation reduces the risk of the combined outcome of neurodevelopmental impairment or death in very low birth weight infants.
We studied a cohort of extremely preterm infants managed with either volume guarantee pressure support ventilation (VGPSV; n=135) or PCV (n=135). Infants were evaluated at 18 months adjusted age with a standardized neurological examination and the Bayley Scales of Infant and Toddler Development-third edition. Logistic regression models were used to evaluate the association of ventilation mode and neurodevelopmental outcome.
Rates of pulmonary interstitial emphysema (odds ratio 0.6; 95% confidence limits: 0.4, 0.8), hypotension (odds ratio: 0.7; 95% confidence limits: 0.5, 0.9) and mortality (odds ratio 0.45; 95% confidence limits: 0.22, 0.9) were lower among infants treated with VGPSV. The infants in the VGPSV group had a significantly shorter duration on mechanical ventilation compared with infants in the PCV group (log-rank test P<0.01). Seventy percent (155/221) of survivors were evaluated at 18 months adjusted age. A trend towards benefit for the combined outcome of death or neurodevelopmental impairment was seen in the VGPSV group but did not reach statistical significance (odds ratio: 0.59; 95% confidence limits: 0.32, 1.08).
VGPSV was associated with a decreased risk of short-term complications but not long-term developmental impairment in this modest-sized cohort.
与压力控制通气（PCV）相比，容量目标通气与新生儿并发症减少相关，包括死亡或支气管肺发育不良的综合结局。然而，其对神经发育结局的影响知之甚少。我们评估了这样一个假设，即与PCV相比，容量目标通气可降低极低出生体重儿神经发育障碍或死亡综合结局的风险。
我们研究了一组极早产儿，他们接受容量保证压力支持通气（VGPSV；n = 135）或PCV（n = 135）治疗。在矫正年龄18个月时，对婴儿进行标准化神经学检查和贝利婴幼儿发育量表第三版评估。采用逻辑回归模型评估通气模式与神经发育结局的关联。
接受VGPSV治疗的婴儿发生肺间质气肿（优势比0.6；95%置信区间：0.4, 0.8）、低血压（优势比：0.7；95%置信区间：0.5, 0.9）和死亡率（优势比0.45；95%置信区间：0.22, 0.9）较低。与PCV组婴儿相比，VGPSV组婴儿机械通气时间显著缩短（对数秩检验P<0.01）。70%（155/221）的幸存者在矫正年龄18个月时接受了评估。VGPSV组在死亡或神经发育障碍综合结局方面有获益趋势，但未达到统计学意义（优势比：0.59；95%置信区间：0.32, 1.08）。
在这个规模适中的队列中，VGPSV与短期并发症风险降低相关，但与长期发育障碍无关。
