Intervention Review

Elective high frequency jet ventilation versus conventional ventilation for respiratory distress syndrome in preterm infants

  1. Tushar Bhuta1,*,
  2. David J Henderson-Smart2

Editorial Group: Cochrane Neonatal Group

Published Online: 27 APR 1998

Assessed as up-to-date: 3 NOV 2002

DOI: 10.1002/14651858.CD000328


How to Cite

Bhuta T, Henderson-Smart DJ. Elective high frequency jet ventilation versus conventional ventilation for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD000328. DOI: 10.1002/14651858.CD000328.

Author Information

  1. 1

    Royal North Shore Hospital, Department of Neonatal Medicine, Sydney, New South Wales, Australia

  2. 2

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

*Tushar Bhuta, Department of Neonatal Medicine, Royal North Shore Hospital, Pacific Highway, St Leonards, Sydney, New South Wales, 2065, Australia. tbhuta@med.usyd.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 27 APR 1998

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Pulmonary disease continues to be the major cause of mortality and morbidity in very low birth weight infants. Chronic lung disease (CLD) following mechanical ventilation for respiratory distress syndrome (RDS) is still a problem despite increased use of antenatal steroids and surfactant replacement therapy. Immaturity, barotrauma, volutrauma and oxygen toxicity are thought to be important factors in the cause of CLD. There is some evidence from animal and adult human studies that adequate ventilation can be achieved at lower pressures when using high frequency jet ventilation (HFJV, about 200-400 breaths per minute) compared to conventional ventilation (CV, 30-80 breaths per minute).

Objectives

The objective of this review was to determine whether the elective (commencing soon after initiation of mechanical ventilation) use of high frequency jet ventilation, as compared to conventional ventilation in preterm infants with respiratory distress syndrome (RDS), would decrease the incidence of chronic lung disease without adverse effects.

Search methods

Randomized trials from MEDLINE were identified by means of MeSH and text words 'high frequency ventilation', 'high frequency jet ventilation', 'jet ventilation' from the years 1980 to October 2002. The EMBASE database (1982-2002), the Oxford Database of Perinatal Trials, the Neonatal Trials Register of the Neonatal Review Group of the Cochrane Collaboration and The Cochrane Library (Issue 3, 2002) were also accessed.

Selection criteria

All randomized controlled trials of elective high frequency jet ventilation versus conventional ventilation in preterm infants born at less than 35 weeks GA or with a birth weight less than 2000 gms with respiratory distress were included in the systematic review. Trials which used HFJV to 'rescue' preterm infants due to severe respiratory distress usually beyond 24 hours, and trials that used HFJV for a mandatory time period and then switched back to CV, were not included in this review.

Data collection and analysis

The standard methods of the Neonatal Cochrane Review Group were used, including independent trial assessment and data extraction. Data were analysed using relative risk (RR) and risk difference (RD). From 1/RD the number needed to treat (NNT) for benefits and number needed to harm (NNH) for adverse outcomes were calculated.

Main results

Overall analysis of the three trials showed that HFJV is associated with a reduction in CLD at 36 weeks postmenstrual age in survivors [RR 0.58 (0.34, 0.98), RD -0.138 (-0.268, -0.007), NNT 7 (4, 90)]. The use of home oxygen therapy was evaluated in only one study (Keszler 1997) and a lower rate was found in the HFJV group [RR 0.24 (0.07, 0.79), RD -0.176 (-0.306, -0.047), NNT 5 (3, 21)]. Overall there was a trend towards an increase in the risk of PVL in the HFJV group, which was not significant. Subgroup analyses shows a significant increase in risk of PVL in the trial by Wiswell 1996 [RR 5.0 (1.19, 21.04), RD 0.250 (0.069, 0.431), NNH 4.0 (2.3,14.5)] where a 'low volume strategy' was the standard protocol for HFJV. In the other trial by Keszler 1997, where the intention was to use a 'high volume strategy', there was no significant difference in the incidence of PVL, RR 0.42 (0.14, 1.30).

In the overall analysis, there were no significant differences in the incidence of neonatal mortality, IVH all grades or in grades 3 or 4 IVH. In the subgroup where 'low volume strategy' was used there was a non-significant trend toward an increase in risk of IVH all grades and grades 3 or 4 IVH.

Authors' conclusions

The overall analysis shows a benefit in pulmonary outcomes in the group electively ventilated with HFJV. Of concern is the significant increase in acute brain injury in one trial which used lower mean airway pressures when ventilating with HFJV. There are as yet no long term pulmonary or neurodevelopmental outcomes from any of the trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Elective high frequency jet ventilation versus conventional ventilation for respiratory distress syndrome in preterm infants

High frequency jet ventilation may help reduce chronic lung disease in preterm babies but adverse effects are unclear. Lung disease is a major cause of death in very low birth weight babies. Chronic lung disease (CLD) following mechanical ventilation for babies with breathing difficulties is also common. It is possible that the low gas exchange in newborns during breathing may help cause chronic lung disease. Elective high frequency jet ventilation (HFJV) is one type of mechanically assisted breathing method that may improve gas exchange in neonates without injuring the lung. The review of trials found there may be benefits of HFJV but not enough evidence of adverse effects. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

選擇性高頻噴射通氣治療與常規通氣治療早產兒呼吸窘迫症候群

肺部疾病一直是極低出生體重兒致病與死亡的主要原因。儘管產前類固醇和表面活性劑置換療法使用已增加,呼吸窘迫症候群(RDS)機械通氣治療造成慢性肺部疾病(CLD)的問題仍然存在。被認為造成CLD的重要因素有肺未成熟,氣壓傷,容積傷和氧毒性。有些動物和成人的研究證據顯示,當使用高頻噴射通氣(HFJV,大約每分鐘200 400次呼吸)可以低壓狀態達到常規通氣(CV,每分鐘 30 – 80次呼吸)相當的適量的通氣。

目標

本回顧的目的是確定對呼吸窘迫症候群(RDS)的早產兒採用選擇性(在機械通氣開始後不久即開始)高頻噴射通氣,與常規通氣比較是否減少慢性肺疾的發病率,且無不良反應。

搜尋策略

用醫學主題詞(MeSH)和自由詞‘high frequency ventilation’, ‘high frequency jet ventilation’, ‘jet ventilation’查找1980年到2002年10月的MEDLINE中的隨機試驗。還檢索了EMBASE database(1982年至2002年),Oxford Database of Perinatal Trials, the Neonatal Trials Register of the Neonatal Review Group of the Cochrane Collaboration and The Cochrane Library (2002年第3期)。

選擇標準

所有對胎齡小於35週或出生體重低於2千克的呼吸窘迫症候群早產兒進行比較選擇性高頻噴射通氣與常規通氣治療的隨機對照試驗均可納入本系統性回顧。而超過24小時後使用高頻噴射通氣‘搶救’重症呼吸窘迫早產兒的試驗,以及使用高頻噴射通氣一段規定時間然後轉回常規通氣治療的試驗不納入本回顧。

資料收集與分析

使用Neonatal Cochrane Review Group的標準方法,包括獨立地評估試驗和提取數據。使用相對風險(RR)和風險差(RD)分析數據。根據 1/RD計算得到避免一例不良結局需治療人數(NNT)和出現一例不良結局需受傷害的人數(NNH)。

主要結論

對三項試驗的整體分析顯示,HFJV使36週胎齡存活兒的CLD下降[RR 0.580.34,0.98),RD −0.138(−0.268,−0.007),NNT 7(4,90)]。僅有一項試驗評估居家氧氣療法(Keszler 1997年),發現HFJV 發生率較低 [RR 0.24(0.07,0.79),RD −0.176(−0.306,−0.047),NNT 5(3,21)] 。整體而言,HFJV組PVL有增加的傾向,但不顯著。Wiswell 1996年進行的試驗亞組分析顯示PVL風險顯著增加[RR 5.0(1.19,21.04),RD 0.250(0.069,0.431),NNH 4.0(2.3,14.5)],在該試驗中的‘低流量策略’是HFJV標準方案。在另一項由Keszler 1997年嘗試的以‘高流量策略’的試驗中,PVL發生率無統計上顯著差異,RR 0.42(0.14,1.30)。整體分析,新生兒死亡率,所有等級的IVH或第3或4級IVH都沒有顯著差異。 在‘低流量策略’的亞組有未達顯著差異地增加所有等級的IVH與第3或4級IVH的風險。

作者結論

整體分析結果顯示選擇性使用HFJV組的肺部保護有幫忙。令人關注的是在一項使用較低平均氣道壓力進行HFJV的試驗中,在急性腦損傷有統計學意義地增加。這些研究至今還沒有發表肺或神經發展的長期預後。

翻譯人

本摘要由臺中榮民總醫院葉惠英翻譯。

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

總結

高頻噴射通氣治療可能有助於減少早產兒慢性肺病的發生但不良反應仍然未知。肺病一直是極低出生體重兒的主要死因。呼吸困難嬰兒也常見用呼吸器後造成慢性肺病。在新生兒氣交換少可能有助於慢性肺病產生。選擇性使用HFJV是一種呼吸器輔助呼吸的方法可能可以在不傷害肺部下改善新生兒氣體交換。本回顧發現HFJV可能有幫忙,但有關不良反應的證據還不夠。需要再進一步的研究。