Pediatric Intensive Care Unit, Groupe Hospitalier du Havre, Montivilliers, France -
Department of Pulmonology, Groupe Hospitalier du Havre, Montivilliers, France.
Minerva Anestesiol. 2017 Jun;83(6):624-637. doi: 10.23736/S0375-9393.17.11708-6. Epub 2017 Feb 13.
Non-invasive ventilation (NIV) is a common treatment for bronchiolitis. However, consensus concerning its efficacy is lacking. The aim of this systematic review was to assess NIV effectiveness to reduce respiratory distress. Secondary objectives were to summarize the effects of NIV, identify predictive factors for failure and describe settings and applications.
Literature searches were conducted in MEDLINE/PubMed, PEDro, Cochrane, EMBASE, CINAHL, Web of Science, UpToDate, and SuDoc from 1990 to April 2015. Randomized controlled trials, controlled non-randomized trials and prospective studies of NIV (continuous positive airway pressure [CPAP], bi-level CPAP, or neurally-adjusted ventilator assist) for bronchiolitis in infants younger than 2 years were included.
Fourteen studies were included, for a total of 379 children. Of these, 357 were treated with NIV as first intention. Respiratory distress, heart rate, respiratory rate and respiratory effort improved (P<0.05). Results were inconclusive regarding prevention of endotracheal intubation. Few adverse events were reported. NIV reduced carbon dioxide pressure (pCO2) in 10 studies. Two randomized controlled studies reported a decrease of 7 mmHg in pCO2 (P<0.05). Predictive factors of NIV failure were apneas, high pCO2, young age, low weight, elevated heart rate and high pediatric risk of mortality score. NIV is mostly administered through a nasal mask, nasal cannula or helmet, with an initial expiratory positive airway pressure of 7 cmH2O.
NIV shows promising results for the reduction of respiratory distress in acute viral bronchiolitis, as shown in several recent studies. However, there is a lack of robust studies to confirm this.
无创通气（NIV）是毛细支气管炎的常用治疗方法。然而，其疗效尚缺乏共识。本系统评价的目的是评估 NIV 降低呼吸窘迫的效果。次要目标是总结 NIV 的效果，确定失败的预测因素，并描述设置和应用。
从 1990 年至 2015 年 4 月，在 MEDLINE/PubMed、PEDro、Cochrane、EMBASE、CINAHL、Web of Science、UpToDate 和 SuDoc 中进行了文献检索。纳入了婴儿（年龄<2 岁）毛细支气管炎的 NIV（持续气道正压通气[CPAP]、双水平 CPAP 或神经调节通气辅助）的随机对照试验、对照非随机试验和前瞻性研究。
共纳入 14 项研究，共 379 例儿童。其中 357 例患儿首次接受 NIV 治疗。呼吸窘迫、心率、呼吸频率和呼吸努力均有改善（P<0.05）。关于预防气管内插管的结果尚无定论。报告的不良事件很少。10 项研究报告 NIV 降低了二氧化碳分压（pCO2）。两项随机对照研究报告 pCO2 降低了 7mmHg（P<0.05）。NIV 失败的预测因素包括：呼吸暂停、高 pCO2、年龄小、体重低、心率高和儿科病死率评分高。NIV 主要通过鼻罩、鼻插管或头盔进行，初始呼气正压为 7cmH2O。
几项近期研究表明，NIV 对急性病毒性毛细支气管炎的呼吸窘迫有较好的疗效，但缺乏强有力的研究来证实这一点。
