University of Southampton, Health sciences department, Neonatology, Southampton, UK.
J Matern Fetal Neonatal Med. 2021 Sep;34(17):2900-2909. doi: 10.1080/14767058.2019.1671332. Epub 2019 Oct 7.
Noninvasive high-frequency oscillatory ventilation (NHFOV) keeps the lung open with add-on effective rhythmic oscillations in addition to allowing spontaneous breathing. This review aims at reconstructing the different pieces of available research articles and evidence into a more solid collective evidence for NHFOV in preterm infants with respiratory distress syndrome (RDS).
A thorough systemic search was conducted in Medline, Embase, Web of Science, Google Scholar, CINAHL, and Cochrane. Randomized controlled trials (RCTs) on preterm infants with RDS comparing NHFOV with nasal continuous positive airway pressure (NCPAP) in terms of PCO change, need for ventilation, duration of respiratory support, mortality air leak, or BPD were included. Data quality assessment and meta-analyses were carried out.
Five RCTs involving 270 preterm infants included in the review. PCO relatively decreased on NHFOV (MD = 3.84, confidence interval (CI) 7.32-0.35, = .03). On the other hand, relative risk (RR) of intubation was unquestionably decreased with NHFOV in comparison with NCPAP (RR = 0.43, CI 0.25-0.75, = .003) without statistical heterogeneity = 0%. Although the risk of mortality was less in NHFOV, the difference was statistically insignificant (RR = 0.72, CI 0.24-2.18, = .56). Other outcomes reported in single studies only. Duration of respiratory support was significantly shorter in NHFOV compared with NCPAP (37.35 ± 8.96 versus 49.77 ± 10.33, = .009), whereas air leak and BPD were reported in very few cases without a significant difference between the two interventions.
NHFOV improved the PCO elimination and decreased the risk of intubation without a significant change in mortality compared with NCPAP.
无创高频振荡通气（NHFOV）通过附加有效的节律性振荡来保持肺部开放，同时允许自主呼吸。本综述旨在将不同的研究文章和证据整合成更具说服力的关于早产儿呼吸窘迫综合征（RDS）的 NHFOV 的综合证据。
在 Medline、Embase、Web of Science、Google Scholar、CINAHL 和 Cochrane 中进行了全面的系统性检索。纳入了比较 NHFOV 与鼻塞持续气道正压通气（NCPAP）治疗 RDS 早产儿的随机对照试验（RCT），评估指标为 PCO 变化、通气需求、呼吸支持持续时间、死亡率、气胸或 BPD。进行了数据质量评估和荟萃分析。
共纳入 5 项 RCT 研究，涉及 270 例早产儿。NHFOV 组 PCO 相对降低（MD = 3.84，置信区间（CI）7.32-0.35， = .03）。另一方面，与 NCPAP 相比，NHFOV 组气管插管的相对风险（RR）显著降低（RR = 0.43，CI 0.25-0.75， = .003），且无统计学异质性 = 0%。虽然 NHFOV 组的死亡率较低，但差异无统计学意义（RR = 0.72，CI 0.24-2.18， = .56）。其他结局仅在单篇研究中报道。NHFOV 组呼吸支持持续时间明显短于 NCPAP 组（37.35 ± 8.96 与 49.77 ± 10.33， = .009），而气胸和 BPD 的发生率在两种干预措施之间无显著差异。
与 NCPAP 相比，NHFOV 可改善 PCO 清除，降低插管风险，且死亡率无显著变化。
