Intervention Review

Rescue high frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants

  1. Vinay H Joshi2,
  2. Tushar Bhuta1,*

Editorial Group: Cochrane Neonatal Group

Published Online: 25 JAN 2006

Assessed as up-to-date: 30 AUG 2005

DOI: 10.1002/14651858.CD000437.pub2


How to Cite

Joshi VH, Bhuta T. Rescue high frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD000437. DOI: 10.1002/14651858.CD000437.pub2.

Author Information

  1. 1

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

  2. 2

    Sydney Children's Hospital, Children's Intensive Care Unit, 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: 25 JAN 2006

SEARCH

 

Abstract

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

Background

Chronic pulmonary disease is a major cause of mortality and morbidity in very low birth weight infants despite increased use of antenatal steroids and surfactant therapy. Ventilator injury and oxygen toxicity are thought to be important factors in the pathogenesis of chronic pulmonary disease. There is evidence in animal studies and adult human studies that high frequency jet ventilation may reduce the severity of lung injury associated with mechanical ventilation.

Objectives

In preterm infants with severe pulmonary dysfunction, does the use of high frequency jet ventilation (HFJV) compared to conventional ventilation (CV) reduce mortality and morbidity without an increase in adverse effects?

Search methods

We searched MEDLINE (1966 - August 2005), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2005), and EMBASE (1988 - August 2005). Information was also obtained from experts in the field and cross references were checked.

Selection criteria

Randomized and quasi-randomized controlled trials of rescue high frequency jet ventilation versus conventional ventilation in preterm infants born at less than 35 weeks of gestation or with a birth weight less than 2000 grams with respiratory distress were included in the systematic review.

Data collection and analysis

The standard methods of the Cochrane Neonatal Review Group were used, including independent trial assessment and data extraction. Data were analysed using relative risk (RR) and risk difference (RD).

Main results

Two randomized trials were identified. One trial (Engle 1997) was excluded as the study was restricted to term and near-term infants. The included trial (Keszler 1991) randomized 166 preterm infants and reported data on 144 infants. Cross-over to the alternate treatment was permitted if the initial treatment failed. There was no statistically significant difference in the overall mortality (including survival after cross-over) between the two groups [RR 1.07, (95% CI 0.67, 1.72)]. The survival by original assignment was identical. In a secondary analysis, the study demonstrated rescue treatment with HFJV, up until the time of cross-over, was associated with lower mortality, [RR 0.66 (95% CI 0.45,0.97)]. No significant differences were found in the incidence of CLD in survivors at 28 days of age, IVH, new air leaks, airway obstruction and necrotizing tracheobronchitis.

Authors' conclusions

There was no significant difference in the overall mortality between rescue high frequency jet ventilation and conventional groups. In a secondary analysis, rescue treatment with HFJV, up until the time of cross-over, was associated with lower mortality. There was no significant increase in adverse effects like intraventricular hemorrhage, new air leaks, airway obstruction and necrotizing tracheobronchitis with rescue high frequency jet ventilation. The included study was done before the introduction of surfactant and widespread use of antenatal steroids. The number of infants included was small and there were high numbers of post randomization exclusions. Due to the crossover design and small numbers of infants in the included study, there is insufficient information to assess the effectiveness of rescue HFJV in preterm infants. Studies that target the most at-risk population and have appropriate power to assess some of the important outcomes are needed. These trials would also need to incorporate long term pulmonary and neurodevelopmental outcomes.

 

Plain language summary

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

Rescue high frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants

In very low birth weight infants who require support on breathing machines (ventilators), ventilator associated lung injury and the toxic effects of oxygen may be important factors in creating a chronic disturbance in lung function. Compared to routine conventional ventilators, high frequency jet ventilators (breathing machines that introduce short duration pulses of gas under pressure into the airway at a very fast rate) may reduce the severity of lung injury associated with mechanical ventilation. However, there is little evidence to support the use of rescue high frequency jet ventilation in the treatment of preterm infants with severe pulmonary problems. Only one trial is included in this review. This trial did not demonstrate any difference in infants who received high frequency jet ventilation. However, the trial had a small number of patients and did not report on long-term outcomes, therefore, it is difficult to interpret these findings.

 

摘要

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

背景

比較使用高頻噴射呼吸器與傳統型呼吸器救援對有嚴重肺功能障礙的早產兒

儘管越來越多產前類固醇的使用和表面活性劑治療,慢性肺疾病仍是造成極低出生體重兒死亡率和罹病率的重要原因。因呼吸器導致之損傷和氧毒性被認為是造成慢性肺疾病重要的因素。目前在動物實驗及成人的研究結果已有證據顯示,高頻噴射呼吸器也許可減少因呼吸器導致之肺損傷的嚴重程度。

目標

有重度肺功能障礙的早產兒,在沒有增加不利的影響前提下,是否使用高頻噴射呼吸器(HFJV)相對於傳統型呼吸器(cv)可以降低死亡率和罹病率?

搜尋策略

我們檢索 MEDLINE(1966年2005年8月),Cochrane中心臨床對照試驗(中央,Cochrane圖書館,第3期,2005年),EMBASE(1988年 2005年8月)。還包括在該領域的專家和相互參照進行的資料。

選擇標準

懷孕週數不到35週或出生體重低於2000公克併有呼吸窘迫的早產兒以隨機和類隨機對照試驗比較高頻噴射呼吸器與傳統型呼吸器的救援治療。

資料收集與分析

利用Cochrane Neonatal Review Group 標準方法,包括獨立試驗的評估和數據的提取。數據分析使用相對危險度(RR)和風險差(RD)。

主要結論

找到兩個隨機試驗。一個試驗(恩格爾 1997年)被排除,因為此試驗僅限於足月和接近足月的嬰兒。被納入的試驗(凱斯萊 991)隨機分配166位早產兒,最後有144個嬰兒有數據被報告。此研究方法允許在一開始時的治療若失敗,可以使用另ㄧ種替代治療。結果在總死亡率方面,兩組並沒有顯著差異,(包括使用另ㄧ種替代治療後之存活率)[RR 1.07, (95% CI 0.67, 1.72)]。原始分配的兩組存活率是相同的。在次級分析方面,研究顯示高頻噴射呼吸器的搶救治療,直到跨越使用另ㄧ種替代治療的時間,與較低的死亡率有相關[R .66 (95% CI 0.45, 0.97)]。倖存者在28天大時的慢性肺疾病發生率,腦室內出血,新的氣漏症狀,氣道阻塞以及壞死性氣管支氣管炎皆無顯著性差異。

作者結論

使用高頻噴射呼吸器與傳統型呼吸器救援對有嚴重肺功能障礙的早產兒,其總死亡率無顯著差異。在次級分析方面,高頻噴射呼吸器搶救治療,直到跨越使用另ㄧ種替代治療的時間,有較低的死亡率。救援高頻噴射呼吸器並未顯著增加如腦室出血、新的氣漏症狀,氣道阻塞以及壞死性氣管支氣管炎等的不利影響。本回顧所納入的研究是在引入表面張力素和產前類固醇的廣泛使用之前完成的。此試驗的嬰兒數目很少,包括有多數的嬰兒在隨機分配之後被排除。由於此研究允許跨越使用另ㄧ種替代治療的設計以及嬰兒的數非太少,所以並沒有足夠的資料評估早產兒使用救援高頻噴射呼吸器的效果。需要有以最危險的族群為目標和有適當的統計強度以評估一些重要預後的研究。這些試驗還應該要納入肺部和神經發育之長期預後。

翻譯人

本摘要由高雄醫學大學附設醫院廖淑玫翻譯。

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

總結

在需要呼吸機支持(人工呼吸器)的極低出生體重兒,與呼吸器相關之肺損傷和氧毒性作用可能是造成其慢性肺功能異常的重要因素。與傳統呼吸器相比,高頻噴射呼吸器(一種人工呼吸器,可用非常快的速度讓脈衝的高壓氣體在短時間進入氣道)可以減少呼吸器相關之肺損傷的嚴重程度。但是,只有少許證據支持有重度肺部問題的早產兒使用高頻噴射呼吸器作救援治療。本回顧研究只納入一個試驗。而此試驗並未顯示使用高頻噴射呼吸器之嬰兒有任何的差別。然而,此試驗的病人數量少,也沒有長期預後的報告,因此,很難解釋這些研究結果。