Application of permissive hypercapnia ventilation in neonatal respiratory failure / 中国小儿急救医学

ABSTRACT

Objective To investigate the significance of permissive hypercapnia( PHC) in the treat-ment of neonates with respiratory failure using synchronized nasal intermittent positive pressure ventilation. Methods A retrospective study was conducted in 47 neonates with respiratory failure admitted to our NICU during January 2015 to December 2017. The subjects were divided into PHC group ( n =27, PaCO245 ～70 mmHg,1 mmHg=0. 133 kPa) and non-permissive hypercapnia( non-PHC) group( n=20,PaCO235～45 mmHg),respectively. The blood gas indicators(PaO2,PaCO2,PaO2/FiO2) before and after non-invasive ventilation treatment were compared;Ventilator parameters of the two groups ( PIP, PEEP, PiO2 , Ti ) were compared. Duration of oxygen therapy,non-invasive ventilation time,starting time of feeding,length of hospi-tal stay,the incidence of intracranial hemorrhage,air leakage,ventilation induced lung injury,and reintubation rate were compared between the two groups. Results After treatment,the blood gas indexes of PaO2 and OI at 24h in two groups were significantly higher than those before the treatment(P<0. 05). There was no sig-nificant difference on PaO2 and OI between two groups both before and after treatment. PaCO2 was lower in non-PHC group after treatment than that before the treatment(P<0. 05),but it showed no difference in PHC group (P>0. 05). The PIP value of the ventilator parameters in PHC group[(19. 9 ± 2. 7) mmHg] was sig-nificantly lower than that in the non-PHC group[(21. 7 ± 2. 3) mmHg](P<0. 05),and there was no statisti-cally significant difference between the two groups in the other ventilator parameters(P>0. 05). Duration of oxygen therapy,starting time of feeding,the time of using noninvasive ventilation,length of hospital stay in PHC group were shorter obviously than those in non-PHC group [ ( 79. 5 ± 10. 8 ) h vs. ( 92. 7 ± 19. 1 ) h;(34.3±8.8)hvs.(47.1±10.8)h;(67.4±12.3)hvs.(97.6±17.3)h;(11.0±4.6)dvs.(14.0±3.9) d](P<0. 05). The incidences of air leakage,and intracranial hemorrhage showed no significant difference between PHC group and non-PHC group(3/27 cases vs. 4/20 cases;3/27 cases vs. 2/20 cases)(P>0. 05). There was no significant difference between the two groups in the rate of reintubation of invasive ventilation after non-invasive ventilation failure ( 2/27 cases vs. 3/20 cases, P > 0. 05 ) . The incidence of ventilator induced lung injury was significantly lower in PHC group than that in non-PHC group ( 2/27 cases vs. 7/20 cases) ( P<0. 05 ) . Conclusion The effects of treating respiratory failure were similar in PHC group and non-PHC group. However,the PHC treatment could shorten the time of oxygen therapy,non-invasive ventila-tion time and hospitalization time,reduce the incidence of lung injury associated with ventilator. The clinical efficacy of PHC was more significant.