极早产儿应用神经调节辅助通气或同步间歇正压通气时的人机同步性：一项随机交叉先导试验。
Patient-Ventilator Synchrony in Extremely Premature Neonates during Non-Invasive Neurally Adjusted Ventilatory Assist or Synchronized Intermittent Positive Airway Pressure: A Randomized Crossover Pilot Trial.
机构信息
Neonatal Intensive Care Unit, CHI Créteil, Créteil, France.
INSERM, CNRS ERL 7000, IMRB, Université Paris Est Creteil, Créteil, France.
出版信息
Neonatology. 2022;119(3):386-393. doi: 10.1159/000524327. Epub 2022 May 3.
INTRODUCTION
Synchronization of non-invasive ventilation is challenging in extremely premature infants. We compared patient-ventilator synchrony between non-invasive neurally adjusted ventilatory assist (NIV-NAVA) using transdiaphragmatic (Edi) catheter and synchronized intermittent positive airway pressure (SiPAP) using an abdominal trigger.
METHODS
This study was a monocentric, randomized, crossover trial in premature infants born before 28 weeks of gestation, aged 3 days or more, and below 32 weeks postmenstrual age. NIV-NAVA and SiPAP were applied in a random order for 2 h with analysis of data from the second hour. The primary outcome was the asynchrony index.
RESULTS
Fourteen patients were included (median [IQR] gestational age at birth 25.6 (25.3-26.4) weeks, median [IQR] birth weight 755 [680-824] g, median [IQR] postnatal age 26.5 [19.8-33.8] days). The median (IQR) asynchrony index was significantly lower in NIV-NAVA versus SiPAP (49.9% [44.1-52.6] vs. 85.8% [74.2-90.9], p < 0.001). Ineffective efforts and auto-triggering were significantly less frequent in NIV-NAVA versus SiPAP (3.0% vs. 32.0% p < 0.001 and 10.0% vs. 26.6%, p = 0.004, respectively). Double triggering was significantly less frequent in SiPAP versus NIV-NAVA (0.0% vs. 9.0%, p < 0.001). No significant difference was observed for premature cycling and late cycling. Peak Edi and swing Edi were significantly lower in NIV-NAVA as compared to SiPAP (7.7 [6.1-9.9] vs. 11.0 [6.7-14.5] μV, p = 0.006; 5.4 [4.2-7.6] vs. 7.6 [4.3-10.8] μV, p = 0.007, respectively). No significant difference was observed between NIV-NAVA and SiPAP for heart rate, respiratory rate, COMFORTneo scores, apnoea, desaturations, or bradycardias.
DISCUSSION/CONCLUSION: NIV-NAVA markedly improves patient-ventilator synchrony as compared to SiPAP in extremely premature infants.
简介
在极早产儿中，无创通气的同步性具有挑战性。我们比较了经膈肌（Edi）导管的神经调节辅助无创通气（NIV-NAVA）和腹部触发的同步间歇正压通气（SiPAP）之间的患者-呼吸机同步性。
方法
这是一项单中心、随机、交叉试验，纳入了胎龄 28 周以下、3 天或以上、孕龄 32 周以下的早产儿。以随机顺序应用 NIV-NAVA 和 SiPAP 各 2 小时，分析第 2 小时的数据。主要结局是失同步指数。
结果
共纳入 14 名患者（中位[IQR]出生时胎龄 25.6[25.3-26.4]周，中位[IQR]出生体重 755[680-824]g，中位[IQR]生后年龄 26.5[19.8-33.8]天）。与 SiPAP 相比，NIV-NAVA 的失同步指数明显更低（49.9%[44.1-52.6] vs. 85.8%[74.2-90.9]，p<0.001）。与 SiPAP 相比，NIV-NAVA 中无效努力和自动触发的频率明显更低（3.0% vs. 32.0%，p<0.001 和 10.0% vs. 26.6%，p=0.004）。SiPAP 中双触发的频率明显低于 NIV-NAVA（0.0% vs. 9.0%，p<0.001）。在过早触发和延迟触发方面，NIV-NAVA 与 SiPAP 之间无显著差异。与 SiPAP 相比，NIV-NAVA 的峰值 Edi 和摆动 Edi 明显更低（7.7[6.1-9.9] vs. 11.0[6.7-14.5]μV，p=0.006；5.4[4.2-7.6] vs. 7.6[4.3-10.8]μV，p=0.007）。与 SiPAP 相比，NIV-NAVA 对心率、呼吸频率、舒适评分、呼吸暂停、低氧血症或心动过缓无显著影响。
讨论/结论：与 SiPAP 相比，NIV-NAVA 可显著改善极早产儿的患者-呼吸机同步性。
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