Division of Pediatrics, Kyorin University, Tokyo, Japan.
Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Pulmonol. 2022 Nov;57(11):2603-2613. doi: 10.1002/ppul.26108. Epub 2022 Aug 24.
In adults, permissive hypercapnia reduces mortality and ventilation duration. However, in preterm infants, the findings from past research regarding the efficacy and safety of permissive hypercapnia are controversial.
To evaluate the efficacy and safety of permissive hypercapnia versus normocapnia in preterm infants on mechanical ventilation.
MEDLINE, EMBASE, CENTRAL, and CINAHL STUDY SELECTION: Published randomized controlled trials (RCTs), non-RCTs, interrupted time series, cohort studies, case-control studies, and controlled before-and-after studies were included.
Two reviewers independently screened the title, abstract, and full text, extracted data, assessed the risk of bias, and evaluated certainty of evidence (CoE) according to the Grading of Recommendations Assessment and Development and Evaluation approach. A meta-analysis of RCTs was performed using the random-effects model.
Four RCTs (693 infants) and one cohort study (371 infants) were included. No significant differences existed between the permissive hypercapnia and normocapnia groups for bronchopulmonary dysplasia (BPD) (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.74-1.18; very low CoE) and a composite outcome of death or BPD (RR, 1.05; 95% CI, 0.90-1.23; very low CoE). Permissive hypercapnia may increase necrotizing enterocolitis (RR, 1.69; 95% CI, 0.98-2.91; very low CoE), but the null or trivial effect cannot be excluded. No significant differences existed between the two groups for any other outcome assessed (very low-to-low CoE).
The sample sizes were less than the optimal sizes for all outcomes assessed, indicating the need for further trials.
Permissive hypercapnia did not have any significant benefit or harm in preterm infants.
在成人中，允许性高碳酸血症可降低死亡率和通气时间。然而，在早产儿中，过去关于允许性高碳酸血症疗效和安全性的研究结果存在争议。
评估机械通气的早产儿中允许性高碳酸血症与正常碳酸血症的疗效和安全性。
MEDLINE、EMBASE、CENTRAL 和 CINAHL
纳入已发表的随机对照试验（RCT）、非随机对照试验、中断时间序列、队列研究、病例对照研究和对照前后研究。
两名审查员独立筛选标题、摘要和全文，提取数据，评估偏倚风险，并根据推荐评估、制定与评价分级方法评估证据确定性（CoE）。使用随机效应模型对 RCT 进行荟萃分析。
纳入 4 项 RCT（693 名婴儿）和 1 项队列研究（371 名婴儿）。允许性高碳酸血症组与正常碳酸血症组在支气管肺发育不良（BPD）（风险比 [RR]，0.94；95%置信区间 [CI]，0.74-1.18；极低 CoE）和死亡或 BPD 的复合结局（RR，1.05；95%CI，0.90-1.23；极低 CoE）方面无显著差异。允许性高碳酸血症可能增加坏死性小肠结肠炎（RR，1.69；95%CI，0.98-2.91；极低 CoE），但不能排除无效或微小效应。两组在评估的其他任何结局方面均无显著差异（极低至低 CoE）。
所有评估结局的样本量均小于最佳样本量，表明需要进一步的试验。
允许性高碳酸血症对早产儿没有显著的益处或危害。
