Efficacy of noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation as post-extubation respiratory support in preterm infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants.@*METHODS@#China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO2) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).@*RESULTS@#A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO2 at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05).@*CONCLUSIONS@#Compared with NIPPV, NHFOV can effectively remove CO2 and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.

Efficacy and safety of inhalation of pulmonary surfactant using vibrating mesh nebulizers combined with nasal continuous positive airway pressure in the treatment of neonatal respiratory distress syndrome / 中华危重病急救医学

Objective:To investigate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) combined with inhalation of pulmonary surfactant (PS) using vibrating mesh nebulizers in the treatment of neonatal respiratory distress syndrome (RDS).Methods:A prospective study was performed on premature infants with RDS admitted to the First Affiliated Hospital of Bengbu Medical College between December 2020 and June 2021. They were randomly assigned into vibrating mesh atomization technology group and intubation-surfactant-extubation (INSURE) technology group. The two groups were treated with NCPAP combined with PS. PS in the vibrating mesh atomization technology group was inhaled into the lungs by the new vibrating mesh atomization technology, while PS in the INSURE group was injected into the lungs by endotracheal tube. The pH value, arterial partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2), mechanical ventilation via endotracheal tube (MVET) demand rate, duration of respiratory support, secondary use of PS, complications, and hospital mortality were compared between the two groups. The occurrences of adverse events in the two groups were recorded. Results:A total of 42 preterm infants were finally enrolled, including 20 cases in the vibrating mesh atomization technology group and 22 cases in the INSURE technology group. There were no significant differences in blood gas analysis and PaO 2/FiO 2 before PS administration between the two groups. One hour after PS administration, blood gas analysis and PaO 2/FiO 2 were significantly improved in both groups. Compared with the INSURE technology group, the improvement of PaO 2/FiO 2 was more obvious in the vibrating mesh atomization technology group [mmHg (1 mmHg≈0.133 kPa): 198±34 vs. 173±39, P < 0.05], but no significant difference in pH value or PaCO 2 was found between the two groups. The duration of respiratory support in the vibrating mesh atomization technology group was significantly shorter than that in the INSURE technology group (hours: 96±13 vs. 120±18, P < 0.01), but there was no statistical difference in MVET demand rate [5.0% (1/20) vs. 13.6% (3/22), P > 0.05]. The incidence of periventricular-intraventricular hemorrhage (PVH-IVH) in the vibrating mesh atomization technology group was less than that in the INSURE technology group [0% (0/20) vs. 18.2% (4/22)], but no statistical difference was found ( P > 0.05). No significant differences in the secondary use rate of PS and incidence of bronchopulmonary dysplasia (BPD) or other complications were found between the vibrating mesh atomization technology group and the INSURE technology group [5.0% (1/20) vs. 9.1% (2/22), 5.0% (1/20) vs. 4.5% (1/22), both P > 0.05]. There were no deaths or serious adverse events such as pneumothorax, pulmonary hemorrhage, periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) in both groups. Conclusion:Compared with the INSURE technique, NCPAP combined with vibrating mesh atomization technology was also effective and safe in the treatment of RDS, which could significantly improve PaO 2/FiO 2 and shorten the duration of respiratory support. Thus, it was worthy of clinical popularization and application.

Efficacy of pulmonary surfactant combined with caffeine citrate on neonatal respiratory distress syndrome treated with synchronized nasal intermittent positive pressure ventilation / 中国小儿急救医学

Objective@#To investigate the clinical effects of pulmonary surfactant(PS) combined with caffeine citrate on neonatal respiratory distress syndrome(NRDS) treated with synchronized nasal intermittent positive pressure ventilation(SNIPPV).@*Methods@#We collected and analyzed 99 neonates who were diagnosed with NRDS and required SNIPPV treatment from January 2016 to June 2019 in NICU of Shengjing Hospital of China Medical University.According to the different treatment, they were divided into PS+ citrate caffeine combination group and control group.The control group(53 neonates)was treated by PS alone.The combination group(46 neonates)was treated with PS combined with caffeine citrate.The indexes of ventilator time, the time of using oxygen, length of hospital stay and complications were compared between the two groups.@*Results@#The indexes of ventilator time, the time of using oxygen and length of hospital stay of combination group were significantly shorter than those of the control group.The differences were statistically significant(P<0.05). However, the incidences of ventilator associated pneumonia, gastrointestinal dysfunction, arrhythmia and other complications were not significantly different between the two groups(P>0.05).@*Conclusion@#PS combined with caffeine citrate in the treatment of NRDS with SNIPPV could effectively improve the pulmonary function of infants.It could improve the neonatal survival rate and reduce complications.It is worth to be recommended.

Efficacy of sequential heated humidified high flow nasal cannula after extubation in premature infants with pulmonary hemorrhage / 中华实用儿科临床杂志

Objective@#To investigate the clinical efficacy of sequential heated humidified high flow nasal ca-nnula(HHHFNC)after extubation in premature infants with pulmonary hemorrhage.@*Methods@#A total of 52 premature infants with pulmonary hemorrhage were selected, who were randomly (by means of random number table) given nasal intermittent positive pressure ventilation(NIPPV)(27 cases) and HHHFNC (25 cases) as a sequential respiratory su-pport from January 2017 to January 2018 at Suzhou Hospital of Nanjing Medical University were selected.The incidence of the basic conditions of the 2 groups of premature infants [gestational age, birth weight, mechanical ventilation days after pulmonary hemorrhage, high-frequency ventilation, usage of nitric oxide(NO)], blood gas analysis indicators at 1 h before extubation and ventilator parameters including the arterial oxygen partial pressure [pa(O2)], arterial partial pressure of carbon dioxide [pa(CO2)], pH value, positive end-expiratory pressure(PEEP), respiratory rates (RR), peak inspiratory pressure (PIP), fraction of inspiration oxygen (FiO2) were compared.The blood gas analysis after extubation [pa(O2), pa(CO2), pH value] at 1 h, outcome events/complications at the end of treatment (reintubation, uration of oxygen therapy after pulmonary hemorrhage, hospitalization days, bronchial pulmonary hypoplasia, ventilator associated pneumonia, feeding intolerance, neonatal necrotizing enterocolitis, pneumothorax) were also compared.@*Results@#There were no significant differences between the NIPPV group and the HHHFNC group in the following items: gestational age, birth weight, mechanical ventilation days after pulmonary hemorrhage, high-frequency ventilation, usage of NO[(30.5±2.9) weeks vs.(31.6±2.7) weeks, 1 325(818) g vs.1 400(800) g, 5 days vs.4 days, 25.9%(7/27 cases) vs.24.0%(6/25 cases), 7.4%(2/27 cases)vs.0(0/25 cases), all P>0.05]. There were no significant differences between the two groups in blood gas analysis indicators before extubation at 1 h and ventilator parameters [pa(O2), pa(CO2), pH value, PEEP, RR, PIP, FiO2], blood gas analysis [pa(O2), pa(CO2), pH value] after extubation at 1 h (all P>0.05); There were no significant differences between the two groups in reintubation, hospitalization days, bronchial pulmonary hypoplasia, ventilator associated pneumonia, feeding intolerance, neonatal necrotizing enterocolitis, pneumothorax [7.4%(2/27 cases) vs.4.0%(1/25 cases), 43(29) days vs.41(22) days, 40.7%(11/27 cases ) vs.16.0%(4/25 cases), 11.1%(3/27 cases) vs.12.0%(3/25 cases), 37.0%(10/27 cases) vs.32.0%(8/25 cases), 7.4%(2/27 cases ) vs.12.0%(3/25 cases), 7.4%(2/27 cases) vs.12.0%(3/25 cases)] (all P>0.05). The duration of oxygen therapy after pulmonary hemorrhage in the HHHFNC group was shorter than that in the NIPPV group [25(30) days vs.9(22) days, P<0.05].@*Conclusions@#As a sequential respiratory support for preterm infants with pulmonary hemorrhage, HHHFNC has shorter duration of oxygen therapy after pulmonary hemorrhage than that of NIPPV, suggesting that HHHFNC is an ideal non-invasive ventilation treatment.

Analysis of the effectiveness of synchronized nasal intermittent positive pressure ventilation for neonatal respiratory failure / 中国小儿急救医学

Objective To investigate the clinical effect of synchronized nasal intermittent positive pressure ventilation (SNIPPV) in the treatment of neonatal respiratory failure. Methods The clinical data of 52 neonates with respiratory failure treated in our hospital from January 2016 to January 2018 were retrospec-tively analyzed. According to the different treatment methods,they were divided into observation group and control group,26 cases in each group. The children in the observation group were treated with SNIPPV,while those in the control group were treated with synchronized intermittent positive pressure ventilation (SIPPV). Clinical efficacy,changes of blood gas analysis results before and after treatment,oxygen consumption time and hospital stay,and complications were compared between the two groups. Results The respiratory rate and heart rate of the two groups improved after treatment,but there were no significant differences between the two groups(P＞0. 05,respectively). The total effective rate of the observation group was 88. 5%,while that of the control group was 92. 3%,there was no significant difference between the two groups(χ2=0. 221, P＞0. 05). The pH,PaO2,PaCO2and oxygen saturation levels of 24 h after treatment in two groups were im-proved (P＜0. 05,respectively),but there were no significant differences between the two groups (P＞0. 05, respectively). Compared with the control group,the oxygen consumption time and hospitalization time of the observation group were significantly shorter, and the differences were statistically significant ( P ＜0. 05, respectively). And the observation group had fewer complications of ventilator associated pneumonia. Conclusion The effect of SNIPPV in the treatment of neonatal respiratory failure is significant. It could shorten the time of oxygen consumption and hospitalization and reduce the complications. It is worth populari-zing SNIPPV mode assisted ventilation.

Clinical Observation of Different Doses of Calf Pulmonary Surfactant Combined with Nasal Intermittent Posi-tive Pressure Ventilation in the Treatment of Neonatal Respiratory Distress Syndrome / 中国药房

OBJECTIVE:To explore clinical efficacy and compliance of different doses of calf pulmonary surfactant combined with nasal intermittent positive pressure ventilation (NIPPV) in the treatment of neonatal respiratory distress syndrome (NRDS). METHODS:90 children diagnosed as NRDS were collected from neonatal department of our hospital,and were divided into high-dose group,middle-dose group and low-dose group by random number table method,with 30 cases in each group. 3 groups received NIPPV combined with calf pulmonary surfactant;the dose of calf pulmonary surfactant in high-dose group,middle-dose group and low-dose group were 100,70,40 mg/kg,respectively. Blood gas indexes,treatment,hospitalization duration,treatment cost,the incidence of compliance were compared among 3 groups. RESULTS:Before treatment,there was no statistical signifi-cance in pH,PaCO2,PaO2,SaO2 among 3 groups(P>0.05);after treatment,above indexes of 3 groups were all improved signifi-cantly,and the high-dose group was significantly better than middle-dose group and low-dose group,with statistical significance (P0.05). Medication times and hospitalization time of high-dose groups were significantly lower or shorter than those of middle-dose group and low-dose group,with statistical significance (P0.05). CONCLUSIONS:Calf pulmonary surfactant combined with NIPPV could effectively improve the blood gas status of newborn with NRDS. High dose of calf pulmonary surfactant can reduce hospitalization time and doesn’t increase treatment cost and the rate of compliance.

Progress of non-invasive ventilation in the treatment of neonatal respiratory distress syndrome / 国际儿科学杂志

Neonatal respiratory distress syndrome(NRDS) is an important cause of neonatal death.The major clinical treatments are pulmonary surfactant replacement therapy and mechanical ventilation.In order to reduce the serious complications associated with invasive mechanical ventilation,non-invasive ventilation has increasingly been chosen by clinicians.There are many new types of non-invasive ventilation,such as nasal ventilation intermittent positive pressure,nasal continuous positive airway pressure,heated,humidified high-flow nasal cannula.We review literatures to further understand the application of non-invasive ventilation.

Progress in non-invasive ventilation for the treatment of neonatal respiratory disease / 临床儿科杂志

Mechanicalventilation in newborns can be divided into invasive mechanical ventilation and non-invasive me-chanical ventilation. In order to reduce invasive ventilation-induced lung injury, more and more non-invasive ventilation patterns have been used clinically. Early application of nasal intermittent positive pressure ventilation (NIPPV) has become the main mode of non-invasive ventilation in many neonatal intensive care units (NICU). At the same time, the combination with selective pulmonary surfactant can reduce the incidence of chronic lung disease. This article reviews the use and prospect of non-invasive respiratory support modes which include continuous positive airway pressure (CPAP) and bi-level CPAP mode (BiPAP) such as SiPAP and NIPPV. Some modes which are in the research stage were also reviewed including synchronized nasal intermittent positive pressure ventilation, neurally adjusted ventilatory assist and non-invasive high-frequency oscillatory ventilation.

A prospective randomized controlled trial of nasal intermittent positive pressure ventilation for prevention of extubation failure in very low birth weight infants / 中国小儿急救医学

Objective To evaluate the efficacy of nasal intermittent positive pressure ventilation (nIPPV) in preventing extubation failure in very low birth weight infants (VLBWI) compared with nasal continuous positive airway pressure (nCPAP).Methods A single-center randomized controlled trial was conducted from Jun 2012 to Jun 2013 in the NICU of Children's Hospital of Hebei Province.Eighty-four cases of VLBWI (birth weight 700 ～ 1 500 g,gestational age 27 ～ 32 weeks) with respiratory failure and subjected to mechanical ventilation were eligible for the study if they needed non-invasive,assisted ventilation at the time of first extubation attempt.They were randomly assigned to receive nIPPV (40 cases) or nCPAP (44 cases) according to random number table method,using the rate of successful extubation as primary outcome.Blood gas data were obtained and PaO2,PaCO2,FiO2,PaO2/FiO2 were monitored at 0 h,24 h,48 h and 72 h after extubation as enrollment for oxygenation and duration,the rate of successful extubation and the incidence of adverse events including frequent apnea,bronchopulmonary dysplasia,intraventricular hemorrhage,periventricular leukomalacia and retinopathy of prematurity and mortality as secondary outcomes.Results There were no significant differences in the baseline characteristics including the proportion of primary disease,sex,weight,gestational age,score for neonatal acute physiology and application of pulmonary surfactant between nIPPV group and nCPAP group (P ＞ 0.05).There were no significant differences in PaO2,PaCO2 and PaO2/FiO2 ratio between the two groups at 0 h of enrollment (P ＞ 0.05).The values of PaO2 and PaO2/FiO2 ratio in nIPPV group were significantly higher[48 h:PaO2:(63.2 ± 3.6) mmHg vs (52.3 ±6.7) mmHg,PaO2/FiO2:(243.2 ±32.8) mmHg vs (187.6 ±34.0) mmHg;72 h:PaO2:(66.4 ±5.8) mmHg vs (51.8±5.9) mmHg,PaO2/EO2:(280.6 ± 16.8) mmHg vs (245.2 ±40.5) mrnHg;1 rnmHg =0.133 kPa],whereas PaCO2 lower[48 h:(40.3 ±4.8) mmHg vs (49.2 ±6.6) mmHg,72 h:(42.2 ±5.6) mmHg vs (57.3 ± 6.9) mmHg],than nCPAP group at 48 h and 72 h after extubation (P ＜ 0.05).The oxygenation status in nIPPV group were significantly improved at 48 h and 72 h after extubation compared with the intra-group data at 0 h (P ＜ 0.05).The total ventilation time was shorter in nIPPV group than nCPAP group[(130.9 ±46.7) h vs (180.5 ±50.1) h,P ＜0.05],but the oxygen exposure time had no significant difference[(190.6 ± 45.2) h vs (216.8 ± 54.4) h,P ＞ 0.05].The rate of successful extubation in nIPPV group was significantly higher as compared with nCPAP group[92.5％ (37/40) vs 75.0％ (33/44),P ＜ 0.05].The incidence of frequent apnea and bronchopulmonary dysplasia in nIPPV was lower than nCPAP group[15.0％ (6/40) vs 34.1％ (15/44) ;2.5％ (1/40) vs 15.9％ (7/44),P ＜ 0.05].There were no significant differences in the incidence of severe intraventricular hemorrhage,perivenwicular leukomalacia,retinopathy of prematurity,late of infections,necrotizing enterocolitis,patent ductus arteriosus,patent ductus arteriosus operation and mortality before discharge between the two groups (P ＞ 0.05).Conclusion nIPPV after extubation in VLBWI has beneficial effects as compared with nCPAP in improving oxygenation,shortening noninvasive ventilation time,improving the rate of successful extubation,and can reduce the incidence of frequent apnea and bronchial pulmonary dysplasia in VLBWI.

Comparison of Effectiveness of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Positive Pressure Ventilation for the Initial Treatment of Preterm Respiratory Distress Syndrome: A Prospective Pilot Study

PURPOSE: To compare respiratory and clinical outcomes between the currently used strategy of Intubation, Surfactant, Extubation (InSurE) and nasal continuous positive airway pressure (NCPAP) and the alternative strategy of InSurE and nasal intermittent positive pressure ventilation (NIPPV) for the initial treatment of respiratory distress syndrome (RDS) in preterm newborns < or =32 weeks. METHODS: Twenty-six comparable preterm infants with RDS were included in the study; 13 were randomized to NCPAP and 13 to NIPPV. In both groups, the InSurE procedure consisted of intubation, surfactant instillation and 2 h positive pressure ventilation followed by extubation, after which spontaneously breathing newborns were placed on NCPAP or NIPPV. RESULTS: There were no differences in demographic characteristics or cardiorespiratory status among preterm infants enrolled in the study. The reinutation rate was lower among the infants treated with NIPPV than among those on NCPAP (8% vs. 46%, P<0.05) and the rate of aminophylline use between 4 and 7 days of age of was lower in the NIPPV group compared to the NCPAP group (8% vs. 30%, P<0.05). In addition, "InSurE with NIPPV" significantly reduced the overall duration of endotracheal ventilation and shortened the time to first feed compared to "InSurE with NCPAP". CONCLUSION: "InSurE with NIPPV" displayed therapeutic benefits as the initial treatment of preterm RDS when compared with the currently used ventilator strategy, "InSurE with NCPAP" by preventing re-intubation and shortening the duration of endotracheal ventilation.

Clinical study of sequential therapy by synchronized nasal intermittent positive pressure ventilation for preterm infants with respiratory distress syndrome after extubation / 中华实用儿科临床杂志

Objective To assess the efficiency of synchronized nasal intermittent positive pressure ventilation (SNIPPV) as a transitional mode in treatment of neonatal respiratory distress syndrome (RDS) after extubation.Methods In this single-center and randomized controlled trial,preterm infants (gestational age less than 35 weeks)with RDS who received mechanical ventilation were randomly assigned to receive SNIPPV(33 cases) or NCPAP(34 cases) after extubation.Blood gas analysis,prevalence of extubation failure and complications were compared between the 2 groups.Results The Pa (O2) in SNIPPV group was significantly higher but the pa (CO2) was significantly lower than those in the NCPAP group at 3 h and 12 h after extubation respectively(all P ＜ 0.05).Infants treated with SNIPPV had a decreased incidence of hypoxemia,hyperbicarbonatemia and extubation failure compared with those of patients treated with NCPAP (all P ＜ 0.05).SNIPPV group had a decreased incidence of apnea (P =0.000),shorter duration of mechanical ventilation and oxygen treatment duration than those of NCPAP group (all P ＜ 0.05).Conclusions SNIPPV is superior to NCPAP in serving as a transitional mode after extubation for preterm infants with RDS,and should be used in preference after extubation.

A case of juvenile form Pompe's disease manifested as chronic alveolar hypoventilation

We describe a case of the juvenile form of Pompe's disease that presented as primary alveolar hypoventilation due to respiratory muscle involvement. This 17-year-old girl had been asymptomatic until this admission, although she had a delayed puberty. Arterial blood gas analysis, pulmonary function test as well as physical findings were compatible with chronic alveolar hypoventilation syndrome. Since she had lower extremity muscle weakness and pseudomyotonic discharge on electromyography a muscle biopsy was done, which revealed glycogen storage disease. The patient was managed successfully with nasal intermittent positive pressure ventilation.