Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Perinatol. 2021 Apr;41(4):814-823. doi: 10.1038/s41372-020-00833-6. Epub 2020 Nov 11.
To determine the appropriate initial ventilatory mode for neonatal congenital diaphragmatic hernia (CDH) by comparing patient prognosis following conventional mechanical ventilation (CMV) versus high-frequency oscillatory ventilation (HFO).
This multicenter retrospective cohort study was performed at 15 participating hospitals in Japan between 2011 and 2016. The 328 eligible CDH infants were classified into CMV (n = 78) and HFO groups (n = 250) to compare mortality and incidence of bronchopulmonary dysplasia (BPD). Propensity score matching was applied to reduce confounding by indication.
While crude mortality was significantly higher in the HFO than the CMV group, adjusted odds ratio (OR) did not show significant difference in mortality between groups (OR of HFO group: 0.98, 95% confidence interval (CI): 0.57-1.67). Adjusted OR of BPD incidence showed no significant difference between groups (OR of HFO group: 1.66, 95%CI: 0.50-5.49).
Initial ventilatory mode in CDH patients, whether CMV or HFO, does not affect prognosis.
通过比较新生儿先天性膈疝（CDH）患者常规机械通气（CMV）与高频振荡通气（HFO）后的预后，来确定合适的初始通气模式。
这是一项在日本 15 家参与医院进行的多中心回顾性队列研究，时间为 2011 年至 2016 年。将 328 名符合条件的 CDH 婴儿分为 CMV（n=78）和 HFO 组（n=250），比较死亡率和支气管肺发育不良（BPD）的发生率。采用倾向评分匹配来减少混杂因素的影响。
虽然 HFO 组的死亡率明显高于 CMV 组，但调整后的比值比（OR）显示两组死亡率无显著差异（HFO 组的 OR：0.98，95%置信区间（CI）：0.57-1.67）。两组间 BPD 发生率的调整 OR 无显著差异（HFO 组的 OR：1.66，95%CI：0.50-5.49）。
CDH 患者的初始通气模式，无论是 CMV 还是 HFO，都不会影响预后。
