
新生儿高频振荡通气的撤机方式探讨
Research advances in the methods for weaning from high-frequency oscillatory ventilation in neonates
新生儿呼吸衰竭是新生儿重症监护室常见的危重症,尽管临床医生希望最大限度地利用无创呼吸支持,但有些低出生体重早产儿一开始就需要用到有创呼吸支持。高频振荡通气(HFOV)作为治疗呼吸衰竭的重要呼吸管理技术,它允许用小于或等于解剖死腔的潮气量快速输送进行气体交换,利用持续膨胀压使肺均一扩张,但同时对肺组织的反复牵拉作用较小,对肺部有保护作用,从而受到临床医师的青睐,目前临床应用已较为普遍。但对于HFOV后如何拔管撤机目前仍不统一。该文就HFOV的撤机方式进行综述,以期为临床提供帮助。
Neonatal respiratory failure is a serious clinical illness commonly seen in the neonatal intensive care unit (NICU). Although clinicians want to maximize noninvasive respiratory support, some low-birth-weight preterm infants may require invasive respiratory support from the beginning. As an important respiratory management technique for the treatment of respiratory failure, high-frequency oscillatory ventilation (HFOV) allows gas exchange by rapid delivery at a tidal volume lower than or equal to anatomy death volume. Continuous distending pressure was applied to achieve uniform lung expansion, reduce repeated contraction of lung tissue, and exert a protective effect on lung tissue, and so it is preferred by clinicians and has been widely used in clinical practice. However, no consensus has been reached on the methods for weaning from HFOV. This article reviews the methods for weaning from HFOV, so as to provide help for clinical practice.
High-frequency oscillatory ventilation / Weaning method / Neonate
[1] Angus DC, Linde-Zwirble WT, Clermont G, et al. Epidemiology of neonatal respiratory failure in the United States:projections from California and New York[J]. Am J Respir Crit Care Med, 2001, 164(7):1154-1160.
[2] Zhang L, Qiu Y, Yi B, et al. Mortality of neonatal respiratory failure from Chinese northwest NICU network[J]. J Matern Fetal Neonatal Med, 2017, 30(17):2105-2111.
[3] Wang H, Gao X, Liu C, et al. Surfactant reduced the mortality of neonates with birth weight ≥ 1500 g and hypoxemic respiratory failure:a survey from an emerging NICU network[J]. J Perinatol, 2017, 37(6):645-651.
[4] Sklar MC, Fan E, Goligher EC. High-frequency oscillatory ventilation in adults with ARDS:past, present, and future[J]. Chest, 2017, 152(6):1306-1317.
[5] Bryan AC. The oscillations of HFO[J]. Am J Respir Crit Care Med, 2001,163(4):816-817.
[6] Clark RH. The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more[J]. J Perinatol, 2005, 25(4):251-257.
[7] Petrillo F, Gizzi C, Maffei G, et al. Neonatal respiratory support strategies for the management of extremely low gestational age infants:an Italian survey[J]. Ital J Pediatr, 2019, 45(1):44.
[8] 杜立中. 新生儿高频机械通气[J].中国实用儿科杂志, 2016, 31(2):99-103.
[9] Sant'Anna GM, Keszler M. Weaning infants from mechanical ventilation[J]. Clin Perinatol, 2012, 39(3):543-562.
[10] Clark RH. Manual of neonatal respiratory care[M]. Germany:Springer, 2017:337-345.
[11] Roth CJ, Förster KM, Hilgendorff A, et al. Gas exchange mechanisms in preterm infants on HFOV-a computational approach[J]. Sci Rep, 2018, 8(1):13008.
[12] Wakabayashi K, Wilson MR, Tatham KC, et al. Volutrauma, but not atelectrauma, induces systemic cytokine production by lung-marginated monocytes[J]. Crit Care Med, 2014, 42(1):e49-e57.
[13] Harris C, Thorpe SD, Rushwan S, et al. An in vitro investigation of the inflammatory response to the strain amplitudes which occur during high frequency oscillation ventilation and conventional mechanical ventilation[J]. J Biomech, 2019, 88:186-189.
[14] Courtney SE, Durand DJ, Asselin JM, et al. High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants[J]. N Engl J Med, 2002, 347(9):643-652.
[15] Zivanovic S, Peacock J, Alcazar-Paris M, et al. Late outcomes of a randomized trial of high-frequency oscillation in neonates[J]. N Engl J Med, 2014, 370(12):1121-1130.
[16] Tana M, Polglase GR, Cota F, et al. Determination of lung volume and hemodynamic changes during high-frequency ventilation recruitment in preterm neonates with respiratory distress syndrome[J]. Crit Care Med, 2015, 43(8):1685-1691.
[17] Greenough A, Murthy V, Milner AD, et al. Synchronized mechanical ventilation for respiratory support in newborn infants[J]. Cochrane Database Syst Rev, 2016, 19(8):CD000456.
[18] 陈海山, 王明义, 谢雪娴. 早产儿应用高频振荡通气和常频机械通气并发症发生率的Meta分析[J]. 中华新生儿科杂志, 2018, 33(4):291-297.
[19] 赖娟, 杜立中, 熊国强, 等. 1108例新生儿呼吸衰竭的临床流行病学特征[J]. 中国当代儿科杂志, 2016, 18(1):10-14.
[20] 常明, 卢红艳, 相虹, 等. 不同机械通气方式联合肺表面活性物质对新生儿急性肺损伤/急性呼吸窘迫综合征疗效比较[J]. 中国当代儿科杂志, 2016, 18(11):1069-1074.
[21] Lai MY, Chu SM, Lakshminrusimha S, et al. Beyond the inhaled nitric oxide in persistent pulmonary hypertension of the newborn[J]. Pediatr Neonatol, 2018, 59(1):15-23.
[22] Johnson AH, Peacock JL, Greenough A, et al. High-frequency oscillatory ventilation for the prevention of chronic lung disease of prematurity[J]. N Engl J Med, 2002, 347(9):633-642.
[23] Clark RH, Gerstmann DR, Null DM Jr, et al. Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome[J]. Pediatrics, 1992, 89(1):5-12.
[24] Manley BJ, Doyle LW, Owen LS, et al. Extubating extremely preterm infants:predictors of success and outcomes following failure[J]. J Pediatr, 2016, 173:45-49.
[25] Van Velzen A, De Jaegere A, Van der Lee J, et al. Feasibility of weaning and direct extubation from open lung high-frequency ventilation in preterm infants[J]. Pediatr Crit Care Med, 2009, 10(1):71-75.
[26] Tana M, Lio A, Tirone C, et al. Extubation from high-frequency oscillatory ventilation in extremely low birth weight infants:a prospective observational study[J]. BMJ Paediatr Open, 2018, 2(1):e000350.
[27] 周伟, 荣箫. 高频振荡通气在新生儿的应用[J]. 中国新生儿科杂志, 2012, 27(4):217-222.
[28] Aurilia C, Ricci C, Tana M, et al. Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation:report of five cases[J]. Ital J Pediatr, 2017, 43(1):114.
[29] Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome-2019 update[J]. Neonatology, 2019, 115(4):432-450.
[30] Shalish W, Latremouille S, Papenburg J, et al. Predictors of extubation readiness in preterm infants:a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2019, 104(1):F89-F97.
[31] Shalish W, Kanbar L, Kovacs L, et al. The impact of time interval between extubation and reintubation on death or bronchopulmonary dysplasia in extremely preterm infants[J]. J Pediatr, 2019, 205:70-76.e2.
[32] Buzzella B, Claure N, D'Ugard C, et al. A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants[J]. J Pediatr, 2014, 164(1):46-51.
[33] Ferguson KN, Roberts CT, Manley BJ, et al. Interventions to improve rates of successful extubation in preterm infants:a systematic review and meta-analysis[J]. JAMA Pediatr, 2017, 171(2):165-174.
[34] Heath Jeffery RC, Broom M, Shadbolt B, et al. Increased use of heated humidified high flow nasal cannula is associated with longer oxygen requirements[J]. J Paediatr Child Health, 2017, 53(12):1215-1219.
[35] Lemyre B, Davis PG, De Paoli AG, et al. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation[J]. Cochrane Database Syst Rev, 2017, 2:CD003212.
[36] Cummings JJ, Polin RA; Committee on Fetus and Newborn, et al. Noninvasive respiratory support[J]. Pediatrics, 2016, 137(1):e20153758.
[37] 中国医师协会新生儿科医师分会, 中华儿科杂志编辑委员会. 早产儿经鼻间歇正压通气临床应用指南(2019年版)[J]. 中华儿科杂志, 2019, 57(4):248-251.
[38] De Luca D, Dell'Orto V. Non-invasive high-frequency oscillatory ventilation in neonates:review of physiology, biology and clinical data[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(6):F565-F570.
[39] Chen L, Wang L, Ma J, et al. Nasal high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome and ARDS after extubation:a randomized xontrolled trial[J]. Chest, 2019, 155(4):740-748.
[40] 张涛, 高薇薇, 陈佳, 等. 无创高频通气在新生儿呼吸窘迫综合征撤机后的应用[J]. 中华新生儿科杂志(中英文), 2017, 32(2):96-99.
[41] Schmidt B, Roberts RS, Davis P, et al. Caffeine therapy for apnea of prematurity[J]. N Engl J Med, 2006, 354(20):2112-2121.
[42] Doyle LW, Ranganathan S, Cheong JLY. Neonatal caffeine treatment and respiratory function at 11 years in children under 1,251 g at birth[J]. Am J Respir Crit Care Med, 2017, 196(10):1318-1324.