Department of Neonatology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.
Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO, USA.
Arch Dis Child Fetal Neonatal Ed. 2023 Dec 15;109(1):74-80. doi: 10.1136/archdischild-2023-325698.
Measuring exhaled carbon dioxide (ECO) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: 'In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?'.
Systematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022.
Delivery room.
Newborn infants receiving non-invasive ventilation at birth.
ECO measurement plus routine assessment compared with routine assessment alone.
Endotracheal intubation in the delivery room, response to resuscitation, survival and morbidity.
Among 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO may signify airway obstruction and ECO detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question.
Evidence to support the use of an ECO monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed.
CRD42022344849.
在出生时进行无创通气时测量呼出的二氧化碳（ECO）可提供有关肺充气的信息。然而，国际复苏联合会（ILCOR）仅建议使用 ECO 探测器来确认气管内插管的位置。因此，ILCOR 已将一个需要紧急评估的研究问题列为优先事项：“在出生时通过任何非侵入性界面接受间歇正压通气的新生儿中，与仅进行临床评估、脉搏血氧饱和度和/或心电图相比，在临床评估、脉搏血氧饱和度和/或心电图之外使用 ECO 监测仪是否会减少分娩室中的气管内插管、改善复苏反应、提高存活率或降低发病率？”。
通过 Ovid MEDLINE、Embase 和 Cochrane CENTRAL 搜索，对截至 2022 年 8 月 1 日确定的随机和非随机研究进行系统评价。
分娩室。
出生时接受无创通气的新生儿。
ECO 测量加常规评估与单独常规评估相比。
分娩室中的气管内插管、复苏反应、存活率和发病率。
在 2370 篇文章中，有 23 篇被纳入；然而，没有一篇有相关的对照组。尽管这些研究表明 ECO 的缺失可能表明气道阻塞，并且在充分通气的婴儿中 ECO 检测可能先于心率增加，但它们并没有直接解决研究问题。
缺乏支持使用 ECO 监测仪来指导出生时无创正压通气的证据。需要对出生时对新生儿进行无创通气时，除了常规评估外，ECO 测量的有效性进行更多研究。
PROSPERO 注册号：CRD42022344849。
