Ganguly Abhrajit, Makkar Abhishek, Sekar Krishnamurthy
Section of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
Front Pediatr. 2020 Feb 7;8:27. doi: 10.3389/fped.2020.00027. eCollection 2020.
Respiratory management of the extremely low birth weight (ELBW) newborn has evolved over time. Although non-invasive ventilation is being increasingly used for respiratory support in these ELBW infants, invasive ventilation still remains the primary mode in this population. Current ventilators are microprocessor driven and have revolutionized the respiratory support for these neonates synchronizing the baby's breath to ventilator breaths. High frequency ventilators with the delivery of tidal volumes less than the dead space have been introduced to minimize barotrauma and chronic lung disease. Despite these advances, the incidence of chronic lung disease has not decreased. There is still controversy regarding which mode is ideal as the primary mode of ventilation in ELBW infants. The most common modes seem to be pressure targeted conventional ventilation, volume targeted conventional ventilation and high frequency ventilation which includes high frequency oscillatory ventilation, high frequency jet ventilation and high frequency flow interrupter. In recent years, several randomized controlled trials and meta-analyses have compared volume vs. pressure targeted ventilation and high frequency ventilation. While volume targeted ventilation and high frequency ventilation does show promise, substantial practice variability among different centers persists. In this review, we weighed the evidence for each mode and evaluated which modes show promise as the primary support of ventilation in ELBW babies.
极低出生体重（ELBW）新生儿的呼吸管理随着时间不断发展。尽管无创通气在这些ELBW婴儿的呼吸支持中使用越来越多，但有创通气仍是这一群体的主要模式。当前的呼吸机由微处理器驱动，彻底改变了对这些新生儿的呼吸支持，使婴儿的呼吸与呼吸机呼吸同步。已引入潮气量小于死腔的高频呼吸机，以尽量减少气压伤和慢性肺病。尽管有这些进展，但慢性肺病的发生率并未降低。关于哪种模式作为ELBW婴儿的主要通气模式最为理想仍存在争议。最常见的模式似乎是压力目标常规通气、容量目标常规通气和高频通气，其中高频通气包括高频振荡通气、高频喷射通气和高频气流阻断器。近年来，多项随机对照试验和荟萃分析比较了容量目标通气与压力目标通气以及高频通气。虽然容量目标通气和高频通气确实显示出前景，但不同中心之间仍存在很大的实践差异。在本综述中，我们权衡了每种模式的证据，并评估了哪些模式有望作为ELBW婴儿通气的主要支持方式。
