Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Arch Dis Child Fetal Neonatal Ed. 2023 Jul;108(4):408-415. doi: 10.1136/archdischild-2022-324464. Epub 2023 Jan 11.
National Institute for Health and Clinical Effectiveness (NICE), UK, guideline published in 2019 recommends the use of volume-targeted ventilation (VTV). It recommends synchronised intermittent mandatory ventilation (SIMV) over the modes that support-all-breaths, for example, assist control ventilation (ACV). We conducted a systematic review and meta-analysis of the studies comparing SIMV mode with triggered modes supporting all breaths.
Patients: Neonates receiving mechanical ventilation.
SIMV ventilation.Comparison: Modes that support-all-breaths: ACV, pressure support ventilation and neurally adjusted ventilation.
Death before discharge and bronchopulmonary dysplasia (BPD) at 36 weeks' corrected gestation, weaning duration, incidence of air leaks, extubation failure, postnatal steroid use, patent ductus arteriosus requiring treatment, severe (grade 3/4) intraventricular haemorrhage, periventricular leukomalacia and neurodevelopmental outcome at 2 years.Randomised or quasi-randomised clinical trials comparing SIMV with triggered ventilation modes supporting all breaths in neonates, reporting on at least one outcome of interest were eligible for inclusion in the review.
Seven publications describing eight studies fulfilled the eligibility criteria. No significant difference in mortality (OR 0.74, 95% CI 0.32 to 1.74) or BPD at 36 weeks (OR 0.63, 95% CI 0.33 to 1.24), but the weaning duration was significantly shorter in support-all-breaths group with a mean difference of -22.67 hours (95% CI -44.33 to -1.01). No difference in any other outcomes.
Compared with SIMV, synchronised modes supporting all breaths are associated with a shorter weaning duration with no statistically significant difference in mortality, BPD at 36 weeks or other outcomes. Larger studies with explicit ventilator and weaning protocols are needed to compare these modes in the current neonatal population.
The review was prospectively registered with PROSPERO: CRD42020207601.
英国国家卫生与临床优化研究所（NICE）于 2019 年发布的指南建议使用容量目标通气（VTV）。它建议使用同步间歇强制通气（SIMV）替代支持所有呼吸的模式，例如辅助控制通气（ACV）。我们对比较 SIMV 模式与支持所有呼吸的触发模式的研究进行了系统评价和荟萃分析。
患者：接受机械通气的新生儿。
SIMV 通气。比较：支持所有呼吸的模式：ACV、压力支持通气和神经调节通气辅助。
出院前死亡和 36 周校正胎龄时支气管肺发育不良（BPD）、撤机时间、气漏发生率、拔管失败、产后类固醇使用、需要治疗的动脉导管未闭、严重（3/4 级）脑室内出血、脑室周围白质软化和 2 年时的神经发育结局。纳入本综述的研究需为比较 SIMV 与支持所有呼吸的触发通气模式的随机或准随机临床试验，报告至少一个感兴趣的结局。
有 7 篇文献描述了 8 项研究符合纳入标准。两组间死亡率（OR 0.74，95%CI 0.32 至 1.74）或 36 周时 BPD（OR 0.63，95%CI 0.33 至 1.24）无显著差异，但支持所有呼吸的组撤机时间明显缩短，平均差异为-22.67 小时（95%CI -44.33 至-1.01）。其他结局无差异。
与 SIMV 相比，支持所有呼吸的同步模式与撤机时间缩短相关，但死亡率、36 周时 BPD 或其他结局无统计学差异。需要更大规模的研究，明确呼吸机和撤机方案，以比较当前新生儿人群中这些模式的差异。
PROSPERO 注册号：本综述前瞻性地在 PROSPERO 注册：CRD42020207601。
