Kumar Jogender, Meena Jitendra, Debata Pradeep, Sundaram Venkataseshan, Dutta Sourabh, Kumar Praveen
Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Indian J Pediatr. 2024 Aug 1. doi: 10.1007/s12098-024-05211-0.
To compare the efficacy and safety of RAM cannula with short binasal prongs (SBPs) as nasal interfaces in preterm infants requiring nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV).
The authors searched electronic databases (Medline, Embase, and Web of Science) and trial registries from inception until March 15, 2024, for randomized controlled trials (RCTs) comparing the RAM cannula with SBP for delivering nCPAP/NIPPV. They performed a random-effects meta-analysis using RevMan 5.4 software. The primary outcome was failure of nCPAP/NIPPV. Secondary outcomes included nasal injury, mechanical ventilation, air leaks, and mortality.
Five RCTs (825 participants) were included. There was no significant difference in nCPAP/NIPPV failure (RR: 1.04; 95% CI: 0.58 to 1.87) or the need for invasive mechanical ventilation (RR: 1.23; 95% CI: 0.75 to 2.01) between the RAM cannula and SBP groups (low to very low certainty). Compared with infants in the SBP group, those in the RAM cannula group had a significantly lower incidence of moderate to severe nasal injury [(5 RCTs, 825 participants; RR: 0.34; 95% CI: 0.18 to 0.66); low certainty] and any nasal injury [(RR: 0.44; 95% CI: 0.26 to 0.76; very low certainty)]. There was no significant difference in the other clinical outcomes.
In comparison to SBP, the RAM cannula may have little to no effect on nCPAP/NIPPV failure, but the evidence is very uncertain. Low-certainty evidence suggests that the use of RAM cannula possibly results in reduction in moderate to severe nasal trauma in preterm infants receiving nCPAP/NIPPV.
比较带有短双侧鼻叉（SBP）的RAM插管作为鼻接口，用于需要鼻持续气道正压通气（nCPAP）或鼻间歇正压通气（NIPPV）的早产儿的有效性和安全性。
作者检索了电子数据库（Medline、Embase和Web of Science）以及从数据库建立至2024年3月15日的试验注册库，以查找比较RAM插管与SBP用于提供nCPAP/NIPPV的随机对照试验（RCT）。他们使用RevMan 5.4软件进行随机效应荟萃分析。主要结局是nCPAP/NIPPV失败。次要结局包括鼻损伤、机械通气、漏气和死亡率。
纳入了5项RCT（825名参与者）。RAM插管组和SBP组在nCPAP/NIPPV失败（风险比：1.04；95%置信区间：0.58至1.87）或有创机械通气需求（风险比：1.23；95%置信区间：0.75至2.01）方面无显著差异（低至极低确定性）。与SBP组的婴儿相比，RAM插管组的婴儿中度至重度鼻损伤发生率显著更低[（5项RCT，825名参与者；风险比：0.34；95%置信区间：0.18至0.66）；低确定性]以及任何鼻损伤发生率[（风险比：0.44；95%置信区间：0.26至0.76；极低确定性）]。其他临床结局无显著差异。
与SBP相比，RAM插管可能对nCPAP/NIPPV失败几乎没有影响，但证据非常不确定。低确定性证据表明，使用RAM插管可能会减少接受nCPAP/NIPPV的早产儿的中度至重度鼻外伤。
