Kuitunen Ilari, Rannankari Markus, Räsänen Kati
Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
Department of Pediatrics and Neonatology, Kuopio University Hospital, Kuopio, Finland.
Pediatr Pulmonol. 2025 Jan;60(1):e21525. doi: 10.1002/ppul.27293. Epub 2024 Sep 27.
We Aimed to analyze for which indications neurally adjusted ventilatory assist (NAVA) has been studied in pediatric patients by conducting a scoping review. PubMed, Scopus, and Web of Science databases were searched in September 2023. We included all randomized trials (including crossover, parallel, and cluster) comparing NAVA to other invasive ventilation modalities in children aged <18 years. We had three key outcomes. What have been the patient and disease groups where NAVA has been studied? What kind of trials and what has been the risk of bias in these randomized trials? What have been the most used outcomes and main findings? The risk of bias was assessed according to the risk of bias 2.0 tool. This review has been reported as preferred in PRISMA-ScR guidelines. After screening 367 abstracts, 27 full reports were assessed and finally 13 studies were included. Six studies were conducted in neonates and seven in older pediatric patients. Ten of the studies were crossover and three were parallel randomized. Overall risk of bias was low in two studies, had some concerns in six studies, and was high in five studies. Most issues came from the randomization process and bias in the selection of reported results. Most used outcomes were changes in clinical parameters or measurements (such as ventilation peak and mean airway pressures, oxygenation index), and ventilator synchrony. Three parallel group trials focused on ventilation duration. The majority of the studies found NAVA as a possible alternative ventilation strategy. Although NAVA is a widely used strategy in neonatal and pediatric intensive care the current literature has notable limitations due to the risk of bias in the original studies and lack of parallel studies focusing on clinical or cost-effectiveness outcomes.
我们旨在通过进行一项范围综述，分析在儿科患者中针对哪些适应症对神经调节通气辅助（NAVA）进行了研究。于2023年9月检索了PubMed、Scopus和Web of Science数据库。我们纳入了所有将NAVA与其他有创通气模式进行比较的随机试验（包括交叉试验、平行试验和整群试验），试验对象为18岁以下儿童。我们有三个关键结果。NAVA所研究的患者和疾病群体有哪些？进行了哪些类型的试验，这些随机试验中的偏倚风险如何？最常用的结果和主要发现是什么？根据偏倚风险2.0工具评估偏倚风险。本综述已按照PRISMA-ScR指南的要求进行报告。在筛选了367篇摘要后，评估了27份完整报告，最终纳入13项研究。六项研究针对新生儿，七项针对大龄儿科患者。其中十项研究为交叉试验，三项为平行随机试验。两项研究的总体偏倚风险较低，六项研究存在一些问题，五项研究的偏倚风险较高。大多数问题来自随机化过程以及报告结果选择中的偏倚。最常用的结果是临床参数或测量值的变化（如通气峰值和平均气道压力、氧合指数）以及通气同步性。三项平行组试验关注通气持续时间。大多数研究发现NAVA是一种可能的替代通气策略。尽管NAVA在新生儿和儿科重症监护中是一种广泛使用的策略，但由于原始研究存在偏倚风险以及缺乏关注临床或成本效益结果的平行研究，当前文献存在显著局限性。
