Department of Respiratory Care, Boston Children's Hospital, Boston Massachusetts.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and.
Respir Care. 2020 May;65(5):693-704. doi: 10.4187/respcare.07720. Epub 2020 Mar 24.
Respiratory support of the critically ill neonate has steadily shifted from invasive to noninvasive forms of support. There have recently been a number of important advances in our understanding of the changes to neonatal resuscitation practices as they pertain to clinically important outcomes, mechanisms of gas exchange for high-flow nasal cannula, and best use of noninvasive ventilation and predicting response. Although the proportion of infants requiring intubation and mechanical ventilation has decreased, the most severely ill often still require intubation and ventilation. Recently, volume-targeted ventilation, high-frequency ventilation, and different methods of assessing weaning and extubation have been investigated. This review summarizes a number of important advances that have been made in the management of prematurity and neonatal respiratory distress syndrome.
危重新生儿的呼吸支持已从有创形式稳步转向无创形式。最近,我们对新生儿复苏实践的改变有了更多的了解,这些改变与临床重要结局、高流量鼻导管的气体交换机制以及无创通气的最佳使用和反应预测有关。尽管需要插管和机械通气的婴儿比例有所下降,但病情最严重的婴儿通常仍需要插管和通气。最近,人们研究了容量目标通气、高频通气以及评估撤机和拔管的不同方法。这篇综述总结了在早产儿和新生儿呼吸窘迫综合征管理方面取得的一些重要进展。