Nasal continuous positive airway pressure immediately after extubation for preventing morbidity in preterm infants

  • Review
  • Intervention

Authors

  • Peter G Davis,

    Corresponding author
    1. Royal Women's Hospital, Department of Paediatrics, Parkville, Victoria, Australia
    • Peter G Davis, Department of Paediatrics, Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria, 3052, Australia. pgd@unimelb.edu.au.

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  • David J Henderson-Smart

    1. Queen Elizabeth II Research Institute, NSW Centre for Perinatal Health Services Research, Sydney, NSW, Australia
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Abstract

Background

Preterm infants being extubated following a period of intermittent positive pressure ventilation via an endotracheal tube are at risk of developing respiratory failure as a result of apnea, respiratory acidosis and hypoxia. Nasal continuous positive airway pressure appears to stabilise the upper airway, improve lung function and reduce apnea and may therefore have a role in facilitating extubation in this population.

Objectives

To evaluate the effect of management with nasal continuous positive airways pressure (NCPAP) compared to extubation directly to headbox oxygen on the need for additional ventilatory support in preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV),

Search methods

Searches were made of the Oxford Database of Perinatal Trials, PubMed up to November 2007, Cochrane Central Regsiter of Controlled Trials (The Cochrane Library, Issue 4, 2007), previous reviews including cross references, abstracts of conferences and symposia proceedings, expert informants and journal handsearching mainly in the English language.

Selection criteria

All trials utilising random or quasi-random patient allocation, in which NCPAP (delivered by any method) was compared with headbox oxygen for post-extubation care were included. Methodological quality was assessed independently by the two review authors.

Data collection and analysis

Data were extracted independently by the two review authors. Data were analysed using relative risk (RR), risk difference (RD) and number needed to treat (NNT).Prespecified subgroup analysis to determine the impact of different levels of NCPAP, differences in duration of IPPV and use of aminophylline were also performed.

Main results

When applied to preterm infants being extubated following IPPV, nasal CPAP reduces the incidence of respiratory failure (apnea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support [typical RR 0.62 (95% CI 0.51, 0.76), typical RD -0.17 (95% CI -0.23, -0.10), NNT 6 (4,10)].

Authors' conclusions

Implications for practice: nasal CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV.

Implication for research: further definition of the gestational age and weight groups in whom these results apply is warranted. Optimal levels of NCPAP as well as methods of administration remain to be determined.

摘要

背景

拔管後立即使用鼻式連續式正壓呼吸用於預防早產兒合併症

早產兒在使用經氣管內管接間歇式正壓呼吸器一段時間後拔管,較易產生呼吸暫停、呼吸性酸中毒、缺氧而導致呼吸衰竭。鼻式連續式正壓呼吸能穩定上呼吸道、改善肺功能及減少呼吸暫停,因此可能可幫助早產兒拔管。

目標

在早產兒在使用間歇式正壓呼吸器一段時間後拔除氣管內管,與直接使用氧氣頭罩相較,使用鼻式正壓呼吸是否會導致不必再使用額外呼吸支持的比例增加?

搜尋策略

搜尋Oxford Database of Perinatal Trials、MEDLINE至2002年11月、及Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2002) ,並搜尋先前回顧性文章包括交互參考資料、會議摘要、研討會紀錄和專業資料,並以手動搜尋主要為英文的期刊。

選擇標準

所有的試驗將病人利用隨機或半隨機方式分配,比較拔管後使用任何形式的鼻式連續式正壓呼吸與氧氣頭罩,研究方法的品質需經兩位作者分別評估。

資料收集與分析

資料由兩位作者分別選錄,並且分析預先分類的小組,以決定不同程度鼻式連續式正壓呼吸的影響,使用間歇式正壓呼吸器期間及使用茶鹼都用相同的套裝軟體分析。應用相對危險性 (RR) 、風險差 (RD) 、需要被治療的病人數目 (NNT) 來分析資料。

主要結論

鼻式連續式正壓呼吸應用於早產兒使用間歇式正壓呼吸器後拔管者,可減少需要額外呼吸支持的臨床事件發生如呼吸暫停、呼吸性酸中毒以及增加氧氣需求[RR 0.62 (0.49, 0.77), RD −0.17 (−0.24, −0.10), NNT 6 (4,10)]。

作者結論

實行的涵義:鼻式連續式正壓呼吸對於早產兒插管及使用間歇式正壓呼吸器一段時間後,可有效預防拔管失敗。研究的涵義:需要進一步定義出生週數及體重,並決定理想的鼻式連續式正壓呼吸設定及給予的方法。

翻譯人

本摘要由馬偕醫院王臻誼翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

鼻式連續式正壓呼吸,從鼻子提供額外的氣流,可幫助減少早產兒拔管後呼吸問題。早產兒 (出生週數37週以前) 的呼吸需要適當的幫助,有時需要從嘴巴或是鼻子放氣管內管,並由呼吸器給予氧氣(機械性換氣),這種方法可以幫助恢復呼吸,但是當拔管時,呼吸問題會再發生。鼻式連續式正壓呼吸從鼻子提供額外氣流,回顧這些試驗發現鼻式連續式正壓呼吸可在使用一段時間呼吸器後預防拔管失敗。

Plain language summary

Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants

Continuous positive airway pressure (CPAP) provides extra gas flow through the nose and thereby helps keep the lung properly inflated. This helps reduce breathing problems in preterm babies after the tube used to assist breathing is removed from their windpipe. Preterm babies (babies born before 37 weeks) may need help to breathe properly. Sometimes this is given via a tube placed into the windpipe, through the mouth or nose, to give oxygen from a machine (mechanical ventilation). This method helps restore breathing but when the tube is removed (this process of removal is called extubation), breathing problems can occur. Nasal continuous positive airways pressure (NCPAP) provides extra gas flow through the nose and thereby helps keep the lung properly inflated. The review of trials found NCPAP is effective in preventing failure of extubation after a period of mechanical ventilation.

Laički sažetak

Nosni kontinuirani pozitivni pritisak na dišne putove odmah nakon ekstubacije za sprečavanje pobola u nedonoščadi

Kontinuirani pozitivni tlak u dišnim putovima (engl. continuous positive airway pressure – CPAP) pruža dodatni protok plina kroz nos i na taj način pomaže održati plućno krilo ispravno napuhanim. To pomaže smanjivanju problema s disanjem u prijevremeno rođene djece nakon što se cijev korištena za pomaganje disanju ukloni iz djetetova dušnika. Nedonoščad (djeca rođena prije 37. tjedna) može trebati pomoć pri pravilnom disanju. Ponekad se pomoć daje preko cijevi postavljene u dušnik, kroz usta ili nos, čime se daje kisik iz stroja (mehanička ventilacija). Ovaj postupak pomaže vratiti disanje, ali kada se ukloni cijev (taj se proces uklanjanja naziva ekstubacija), može doći do problema s disanjem. Nosni kontinuirani pozitivni tlak na dišne putove (NCPAP) pruža dodatni protok plina kroz nos i na taj način pomaže zadržati plućno krilo ispravno napuhanim. Cochrane sustavni pregled kliničkih studija utvrdio je da NCPAP učinkovito sprječava neuspješne ekstubacije nakon razdoblja mehaničke ventilacije.

Bilješke prijevoda

Hrvatski Cochrane ogranak.
Prevela: Ivana Miošić

Laienverständliche Zusammenfassung

Nasale kontinuierliche Überdruckbeatmung sofort nach der Extubation, um Komplikationen bei Frühgeborenen vorzubeugen

Kontinuierliche positive Überdruckbeatmung (continous positive airway pressure, CPAP) sorgt für einen zusätzlichen Luftstrom durch die Nase und hilft dadurch, die Lunge entfaltet zu halten. Dies trägt dazu bei, Atemprobleme von Frühgeborenen zu vermindern, nachdem der Schlauch, der zur Unterstützung der Atmung in die Luftröhre eingebracht wurde, entfernt wurde. Frühgeborene, d. h. Babies, die vor der 37. Schwangerschaftswoche geboren werden, brauchen unter Umständen Hilfe, um richtig atmen zu können. Manchmal wird mit einer Beatmungsmaschine Sauerstoff über einen Schlauch gegeben, der durch den Mund oder die Nase eingeführt wurde und in der Luftröhre liegt. Diese Methode stellt die Atmung wieder her, jedoch kann es im Anschluss an das Entfernen des Luftröhrenschlauchs (ein Vorgang, der 'Extubation' genannt wird) zu Problemen kommen.Nasale kontinuierliche Überdruckbeatmung (nasal continuous airway pressure, NCPAP) sorgt für einen zusätzlichen Luftstrom durch die Nase und hilft dadurch, die Lunge entfaltet zu halten. Dieser Review fand, dass NCPAP nach einem Zeitraum mit maschineller Beatmung, ein Misslingen der Extubation wirksam verhindert.

Anmerkungen zur Übersetzung

Koordination durch Cochrane Schweiz

Ancillary