Division of Neonatology, Department of Women's and Children's Health, University of Leipzig Medical Center, Leipzig, Germany.
Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
Neonatology. 2021;118(2):235-243. doi: 10.1159/000515818. Epub 2021 Apr 26.
Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.
在过去的几十年中，治疗方法的进步显著提高了极早产儿的存活率。相比之下，主要新生儿疾病的发病率，包括支气管肺发育不良，并没有下降。鉴于有创机械通气与新生儿肺损伤之间的关系已得到充分证实，新生儿科医生一直在寻找高风险婴儿有效非侵入性呼吸支持策略。持续气道正压通气已取代有创机械通气，用于初始稳定和治疗呼吸窘迫综合征。如今，即使是肺损伤风险最高的最小婴儿，也采用了非侵入性呼吸支持。此外，不同模式的非侵入性呼吸支持辅以多种辅助措施和抢救策略已经进入临床实践，目的是预防插管或再次插管。然而，这种毫无疑问的将策略重点转向非侵入性支持的范式转变是否会让我们产生一种虚假的安全感？我们能否在以下方面做得更好：（i）确定那些最适合非侵入性稳定的极不成熟早产儿；（ii）改善个体婴儿非侵入性呼吸支持失败的决定因素和潜在病因；（iii）提高非侵入性呼吸支持的成功率；（iv）更好地预防对发育中肺的最终损害？随着肺损伤风险最高的婴儿存活率的提高和支气管肺发育不良负担的不变，我们应该质疑非侵入性呼吸支持的盲目使用，并解决上述问题。
