Résumé
Abstract@#As a common critically illness among neonates and notably premature infants, respiratory failure is one of the major factors for neonatal deaths. Ventilator, an effective tool for assisted ventilation, is effective to remarkably improve respiratory failure; however, the conventional mechanical ventilation is likely to cause a series of injuries and complications. Therefore, noninvasive ventilation is commonly used in clinical practices. Noninvasive high-frequency oscillatory ventilation is an emerging noninvasive respiratory, in which tracheal intubation is replaced with nasal plug and mask to transfer high-frequency airflow to the airway. It facilities rapid correction of the imbalance of ventilation blood flow ratio, reduction of carbon dioxide retention, increase in oxygen saturation, and reduction in incidence of complications and risk of failure in ventilator withdrawal, which has been employed for the treatment of respiratory failure among neonates. The review descries the applications of noninvasive high-frequency oscillatory ventilation in respiratory support among neonates with respiratory failure, so as to provide insights into the management of respiratory failure among neonates.
Résumé
Objective:To observe the clinical efficacy and safety of non-invasive high frequency oscillatory ventilation(NHFOV) on the early respiratory support in very low birth weight infants with respiratory distress syndrome(RDS).Methods:It was a prospective cohort study involving very low birth weight infants with RDS admitted to the Central Hospital of Chongqing Three Gorges from January 2017 to January 2020 with a gestational age of 28-32 weeks.According to the applied non-invasive respiratory support, very low birth weight infants with NRDS were divided into control group[continuous positive airway pressure (CPAP) group]and observation group(NHFOV group). Therapeutic effect, complications and adverse effects between 2 groups were compared.Results:A total of 78 very low birth weight infants with RDS were included, among which 38 cases were supported with NHFOV group and 40 cases were CPAP group.(1) Therapeutic efficacy: there were no significant differences in the use of pulmonary surfactant and death rate between 2 groups (all P>0.05). Compared with the CPAP group, patients in the NHFOV group had significantly lower incidence of non-invasive ventilation failure(4 cases vs.13 cases), duration of non-invasive ventilation [(7.60±1.68) days vs. (10.75±2.38) days], duration of oxygen exposure [(12.34±2.66) days vs.(17.20±4.36) days] and times of apnea [(1.68±1.57) times/day vs.(4.80±2.60) times/day] (all P<0.05). There was no significant difference in the incidence of complications between 2 groups (all P>0.05). (2) Adverse events: compared with CPAP group, patients in the NHFOV group had significantly lower incidence of abdominal distension [13 cases(34.2%) vs. 25 cases (62.5%)], delayed duration of respiratory secretion disappearance [(12.65±2.33) days vs.(7.87±2.70) days], low viscosity of secretions [thin sputum, 31 cases (81.6%) vs.22 cases (55.0%); ropy sputum, 7 cases (18.4%) vs.18 cases(45.0%)], and less airway obstruction [2 cases (5.2%) vs.15 cases (37.5%)] (all P<0.05). No significant difference in the incidence of nasal septum injury was detected between 2 groups (1 case vs.0) ( P>0.05). Conclusions:NHFOV is safe and effective in the early application of NRDS in very low birth weight infants with RDS, which has less adverse events.It is expected to be used in the treatment of children with frequent apnea and a large number of respiratory secretions that is prone to obstruction.