Clinical effects of different ways of mechanical ventilation combined with pulmonary surfactant in treatment of acute lung injury/acute respiratory distress syndrome in neonates:a comparative analysis
CHANG Ming, LU Hong-Yan, XIANG Hong, LAN Hou-Ping
Department of Neonatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
Abstract：Objective To compare the therapeutic effects of high-frequency oscillatory ventilation+pulmonary surfactant (HFOV+PS), conventional mechanical ventilation+pulmonary surfactant (CMV+PS), and conventional mechanical ventilation (CMV) alone for acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in neonates. Methods A total of 136 neonates with ALI/ARDS were enrolled, among whom 73 had ALI and 63 had ARDS. They were divided into HFOV+PS group (n=45), CMV+PS group (n=53), and CMV group (n=38). The neonates in the first two groups were given PS at a dose of 70-100 mg/kg. The partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/fraction of inspired oxygen (FiO2), oxygenation index (OI), and respiratory index (RI) were measured at 0, 12, 24, 48, and 72 hours of mechanical ventilation. Results At 12, 24, and 48 hours of mechanical ventilation, the HFOV+PS group had higher PaO2 and lower PaCO2 than the CMV+PS and CMV groups (P < 0.05). At 12, 24, 48, and 72 hours of mechanical ventilation, the HFOV+PS group had higher PaO2/FiO2 and lower OI and RI than the CMV+PS and CMV groups (P < 0.05). The HFOV+PS group had shorter durations of mechanical ventilation and oxygen use than the CMV+PS and CMV groups (P < 0.05). There were no significant differences in the incidence rates of air leakage and intracranial hemorrhage and cure rate between the three groups. Conclusions In neonates with ALI/ARDS, HFOV combined with PS can improve pulmonary function more effectively and shorten the durations of mechanical ventilation and oxygen use compared with CMV+PS and CMV alone. It does not increase the incidence of complications.
CHANG Ming,LU Hong-Yan,XIANG Hong et al. Clinical effects of different ways of mechanical ventilation combined with pulmonary surfactant in treatment of acute lung injury/acute respiratory distress syndrome in neonates:a comparative analysis[J]. CJCP, 2016, 18(11): 1069-1074.
Henderson-Smart DJ,De Paoli AG,Clark RH,et al.High frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction born at or near term[J].Cochrane Database Syst Rev,2009,8(3):CD002974.
[3]
Cools F,Offringa M,Askie LM.Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants[J].Cochrane Database Syst Rev,2015,19(3):CD000104.
[4]
Demirakça S,Dötsch J,Knothe C,et al.Inhaled nitric oxide in neonatal and pediatric acute respiratory distress syndrome:dose response,prolonged inhalation,and weaning[J].Crit Care Med,1996,24(11):1913-1919.
Swarnam K,Soraisham AS,Sivanandan S.Advances in the management of meconium aspiration syndrome[J].Int J Pediatr,2012,2012:359571.
[7]
Deterding RR.Infants and young children with children's interstitial lung disease[J].Pediatr Allergy Immunol Pulmonol,2010,23(1):25-31.
[8]
Marini JJ.Mechanical ventilation:past lessons and the near future[J].Critical Care,2013,17(Suppl 1):S1.
[9]
Poddutoor PK,Chirla DK,Sachane K,et al.Rescue high frequency oscillation in neonates with acute respiratory failure[J].Indian Pediatr,2011,48(6):467-470.
Rey-Santano C,Alvarez-Diaz F J,Mielgo V,et al.Bronchoalveolar lavage versus bolus administration of lucinactant,a synthetic surfactant in meconium aspiration in newborn lambs[J].Pediatr Pulmonol,2011,46(10):991-999.
[12]
Donn SM,Dalton J.Surfactant replacement therapy in the neonate:beyond respiratory distress syndrome[J].Respir Care,2009,54(9):1203-1208.
[13]
Willson DF,Thomas NJ,Tamburro R,et al.Pediatric calfactant in acute respiratory distress syndrome trial[J].Pediatr Crit Care Med,2013,14(7):657-665.
[14]
Dushianthan A,Cusack R,Goss V,et al.Clinical review:Exogenous surfactant therapy for acute lung injury/acute respiratory distress syndrome——where do we go from here?[J].Crit Care,2012,16(6):238-245.
Al Ethawi Y.Elective high-frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants[J].J Clin Neonatol,2012,1(3):121-123.
[18]
Tissières P,Myers P,Beghetti M,et al.Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants[J].Intensive Care Med,2010,36(7):1164-1170.
