Bhat Prashanth, Chowdhury Olie, Shetty Sandeep, Hannam Simon, Rafferty Gerrard F, Peacock Janet, Greenough Anne
Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's 22 College London, London, UK.
Division of Health and Social Care Research, King's College London, London, UK.
Eur J Pediatr. 2016 Jan;175(1):89-95. doi: 10.1007/s00431-015-2596-3. Epub 2015 Aug 4.
Our aims were to determine whether volume-targeted ventilation (VTV) or pressure-limited ventilation (PLV) reduced the time to successful extubation and if any difference was explained by a lower work of breathing (WOB), better respiratory muscle strength or less thoracoabdominal asynchrony (TAA) and associated with fewer hypocarbic episodes. Infants born at ≥34 weeks of gestational age were randomised to VTV or PLV. The WOB was assessed by the transdiaphragmatic pressure time product, respiratory muscle strength by the maximum inflation (Pimax) and expiratory (Pemax) pressures and TAA assessed using uncalibrated respiratory inductance plethysmography. Forty infants, median gestational age of 39 (range 34-42) weeks, were recruited. The time to successful extubation did not differ between the two groups (median 25, range 2.5-312 h (VTV) versus 33.5, 1.312 h (PLV)) (p = 0.461). There were no significant differences between the groups with regard to the WOB, respiratory muscle strength or the TAA results. The median number of hypocarbic episodes was 1.5 (range 0-8) in the VTV group versus 4 (range 1-13) in the PLV group (p = 0.005).
In infants born at or near term, VTV compared to PLV did not reduce the time to successful extubation but was associated with significantly fewer hypocarbic episodes.
In prematurely born infants, volume-targeted ventilation (VTV) compared to pressure-limited ventilation (PLV) reduces bronchopulmonary dysplasia or death. In addition, VTV is associated in prematurely born infants with lower incidences of pneumothorax, intraventricular haemorrhage and hypocarbic episodes.
Despite a high morbidity, few studies have investigated optimum ventilation strategies for infants born at or near term. In a RCT, we have demonstrated VTV versus PLV in infants ≥34 weeks gestation was associated with significantly fewer hypocarbic episodes.
我们的目的是确定容量目标通气（VTV）或压力限制通气（PLV）是否能缩短成功拔管时间，以及是否因较低的呼吸功（WOB）、更好的呼吸肌力量或更少的胸腹不同步（TAA）而存在差异，并与较少的低碳酸血症发作相关。孕龄≥34周的婴儿被随机分为VTV组或PLV组。通过跨膈压时间乘积评估WOB，通过最大吸气压力（Pimax）和呼气压力（Pemax）评估呼吸肌力量，并使用未校准的呼吸感应体积描记法评估TAA。招募了40名婴儿，中位孕龄为39（范围34 - 42）周。两组之间成功拔管时间无差异（VTV组中位时间为25小时，范围2.5 - 312小时；PLV组为33.5小时，范围1 - 312小时）（p = 0.461）。两组在WOB、呼吸肌力量或TAA结果方面无显著差异。VTV组低碳酸血症发作的中位数为1.5（范围0 - 8），而PLV组为4（范围1 - 13）（p = 0.005）。
对于足月或近足月出生的婴儿，与PLV相比，VTV并未缩短成功拔管时间，但与显著更少的低碳酸血症发作相关。
与压力限制通气（PLV）相比，容量目标通气（VTV）可降低早产婴儿支气管肺发育不良或死亡的风险。此外，VTV与早产婴儿气胸、脑室内出血和低碳酸血症发作的发生率较低相关。
尽管发病率较高，但很少有研究探讨足月或近足月出生婴儿的最佳通气策略。在一项随机对照试验中，我们证明了孕龄≥34周的婴儿中，VTV与PLV相比，低碳酸血症发作显著更少。
