Weydig Heather, Ali Noorjahan, Kakkilaya Venkatakrishna
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
Neoreviews. 2019 Sep;20(9):e489-e499. doi: 10.1542/neo.20-9-e489.
A decade ago, preterm infants were prophylactically intubated and mechanically ventilated starting in the delivery room; however, now the shift is toward maintaining even the smallest of neonates on noninvasive respiratory support. The resuscitation of very low gestational age neonates continues to push the boundaries of neonatal care, as the events that transpire during the golden minutes right after birth prove ever more important for determining long-term neurodevelopmental outcomes. Continuous positive airway pressure (CPAP) remains the most important mode of noninvasive respiratory support for the preterm infant to establish and maintain functional residual capacity and decrease ventilation/perfusion mismatch. However, the majority of extremely low gestational age infants require face mask positive pressure ventilation during initial stabilization before receiving CPAP. Effectiveness of face mask positive pressure ventilation depends on the ability to detect and overcome mask leak and airway obstruction. In this review, the current evidence on devices and techniques of noninvasive ventilation in the delivery room are discussed.
十年前，早产儿在产房就开始接受预防性插管和机械通气；然而，现在的趋势是即使是最小的新生儿也采用无创呼吸支持。极低孕周新生儿的复苏不断挑战新生儿护理的极限，因为出生后最初几分钟内发生的事件对确定长期神经发育结局愈发重要。持续气道正压通气（CPAP）仍然是早产儿建立和维持功能残气量以及减少通气/灌注不匹配的最重要无创呼吸支持模式。然而，大多数极低孕周婴儿在接受CPAP之前的初始稳定阶段需要面罩正压通气。面罩正压通气的有效性取决于检测和克服面罩漏气及气道阻塞的能力。在这篇综述中，讨论了产房无创通气设备和技术的现有证据。
