使用神经调节通气辅助系统(NAVA)进行无创通气可改善极低出生体重儿的拔管效果。

IF 2 4区 医学 Q2 PEDIATRICS Children-Basel Pub Date : 2024-09-28 DOI:10.3390/children11101184
Kevin Louie, Shaili Amatya, Gad Alpan, Lance A Parton
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引用次数: 0

摘要

研究目的本研究探讨了在极低出生体重儿(ELBW)中,使用气管插管(MVET)的传统机械通气与使用神经调节通气辅助(NAVA)的同步无创正压通气(sNIPPV)和传统无创正压通气(NIPPV)相比,拔管的有效性。方法:机构审查委员会(IRB)批准本研究(#12175)进行单中心随机对照试验,将 60 名 ELBW 婴儿按计算机生成的一对一方案分配给使用 NAVA 的 sNIPPV 或 NIPPV。主要结果包括是否需要再次插管,次要结果包括评估中度/重度 BPD,定义为 36 周时是否需要吸氧,如 #NCT03613987 (clinicaltrials.gov) 所述。结果共有 60 名 ELBW 婴儿参加了随机治疗。总胎龄为 26(1.5)周,出生体重为 773(157)克[平均值(标度)]。NAVA 和 NIPPV 患者的特征在统计学上没有明显差异。NIPPV 组的拔管失败率为 41%,NAVA 组为 35%(P = NS)。NAVA 组的中度和重度 BPD 较少(p = 0.03),氧疗时间较短(p = 0.002),住院时间较短(p = 0.03),家庭供氧需求较少(0,43%;p = 0.0004)。结论:本研究发现,ELBW婴儿的拔管失败率与之前的研究相似。但是,NAVA 组的中度/重度 BPD 发生率和出院时的吸氧需求较低,吸氧治疗持续时间和住院时间也较短。在 ELBW 婴儿中,使用 NAVA 可能是一种合理的无创通气替代模式。
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Non-Invasive Ventilation with Neurally Adjusted Ventilatory Assist (NAVA) Improves Extubation Outcomes in Extremely Low-Birth-Weight Infants.

Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An institutional review board (IRB) approved this study (#12175) to conduct a single-center randomized control trial including 60 ELBW infants assigned in a one-to-one computer-generated scheme to either sNIPPV using NAVA or NIPPV. The primary outcome involved the need for reintubation, and the secondary outcome involved the assessment of moderate/severe BPD, defined as an oxygen requirement at 36 weeks, as in #NCT03613987 (clinicaltrials.gov). Results: There were 60 ELBW infants enrolled and randomized. The overall gestational age was 26 (1.5) weeks, and the birth weight was 773 (157) g [mean (SD)]. There were no statistically significant differences between the NAVA and NIPPV patient characteristics. There was a 41% extubation failure rate in the NIPPV group and 35% in the NAVA group (p = NS). The NAVA group had less moderate and severe BPD (p = 0.03), a shorter oxygen therapy duration (p = 0.002), a decreased length of stay (p = 0.03), and less need for home oxygen (0, 43%; p = 0.0004). Conclusions: This study found similar extubation failure rates among ELBW infants as in prior studies. However, the NAVA group had lower rates of moderate/severe BPD and need for oxygen at discharge, as well as shorter oxygen therapy duration and length of stay. The use of NAVA may be a reasonable alternative mode of non-invasive ventilation in the ELBW population.

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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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