唐氏综合征患儿的长期无创通气：一项系统评价
Long-Term Non-invasive Ventilation in Children With Down Syndrome: A Systematic Review.
作者信息
Hudson Summer, Abusido Tamer, Sebastianski Meghan, Castro-Codesal Maria L, Lewis Melanie, MacLean Joanna E
机构信息
MD Program, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
Divisions of Respiratory Medicine, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
出版信息
Front Pediatr. 2022 May 23;10:886727. doi: 10.3389/fped.2022.886727. eCollection 2022.
CONTEXT
Children with Down syndrome are at risk for obstructive sleep apnea, which may not be resolved by adenotonsillecotmy, as well as other respiratory disorders that may impact breathing during sleep. Long-term non-invasive ventilation, including continuous and bilevel positive airway pressure delivery, is an alternate treatment strategy.
OBJECTIVE
To assess the use and outcomes of long-term non-invasive ventilation in children with Down syndrome including comparison to other children using long-term non-invasive ventilation.
DATA SOURCES
The search strategy for the scoping review used Medical Subject Headings (MeSH) and free-text terms for "child" and "non-invasive ventilation." MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), Cochrane Library (Wiley), and PubMed databases were searched (1990-2021).
STUDY SELECTION
The scoping review results were searched to identify studies including data on at least three children with Down Syndrome using long-term non-invasive ventilation.
DATA EXTRACTION
Study characteristics, subject characteristics, technology type, and outcome measurements were extracted.
RESULTS
A total of 28 articles included 543 children with Down syndrome using long-term non-invasive ventilation. Children with Down syndrome accounted for 18% of children using long-term non-invasive ventilation. Data on efficacy, feasibility, and adherence in children with Down syndrome are comparable to other children. Children with Down syndrome may have greater difficulty initiating long-term non-invasive ventilation, longer time to establish use, and a higher rate of inability to establish use. Outcome data is limited but suggest favorable impact on cardiac function and attention.
LIMITATIONS
Articles related to long-term non-invasive ventilation use in adolescents and young adults may have been excluded.
CONCLUSIONS
Children with Down syndrome make up a significant portion of the population of children using long-term non-invasive ventilation. While there is more limited data available with respect to the use and outcomes for children with Down syndrome compared to the other children, long-term non-invasive ventilation is an effective and well-tolerated therapy with no clear differences in the use or outcomes for children with Down syndrome. Additional work is needed to understand potential challenges around establishing long-term non-invasive ventilation use in children with Down syndrome.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206533, identifier: CRD206533.
背景
唐氏综合征患儿有患阻塞性睡眠呼吸暂停的风险，腺样体扁桃体切除术可能无法解决这一问题，此外还有其他可能影响睡眠期间呼吸的呼吸系统疾病。长期无创通气，包括持续气道正压通气和双水平气道正压通气，是一种替代治疗策略。
目的
评估唐氏综合征患儿长期无创通气的使用情况和疗效，包括与其他使用长期无创通气的患儿进行比较。
数据来源
范围综述的检索策略使用了医学主题词（MeSH）以及“儿童”和“无创通气”的自由文本词。检索了MEDLINE（Ovid）、Embase（Ovid）、CINAHL（Ebsco）、Cochrane图书馆（Wiley）和PubMed数据库（1990 - 2021年）。
研究选择
检索范围综述结果以确定至少纳入三名使用长期无创通气的唐氏综合征患儿数据的研究。
数据提取
提取研究特征、受试者特征、技术类型和结局测量指标。
结果
共有28篇文章纳入了543名使用长期无创通气的唐氏综合征患儿。唐氏综合征患儿占使用长期无创通气患儿的18%。唐氏综合征患儿在疗效、可行性和依从性方面的数据与其他患儿相当。唐氏综合征患儿在启动长期无创通气时可能有更大困难，建立使用的时间更长，无法建立使用的比例更高。结局数据有限，但提示对心脏功能和注意力有积极影响。
局限性
可能排除了与青少年和青年长期无创通气使用相关的文章。
结论
唐氏综合征患儿占使用长期无创通气患儿群体的很大一部分。虽然与其他患儿相比，关于唐氏综合征患儿使用情况和结局的数据更为有限，但长期无创通气是一种有效且耐受性良好的治疗方法，唐氏综合征患儿在使用或结局方面无明显差异。需要开展更多工作来了解在唐氏综合征患儿中建立长期无创通气使用方面的潜在挑战。
系统综述注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206533，标识符：CRD206533 。
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