Intervention Review

Continuous distending pressure for respiratory distress in preterm infants

  1. Jacqueline J Ho1,*,
  2. Prema Subramaniam2,
  3. David J Henderson-Smart3,
  4. Peter G Davis4

Editorial Group: Cochrane Neonatal Group

Published Online: 22 APR 2002

Assessed as up-to-date: 23 MAY 2008

DOI: 10.1002/14651858.CD002271


How to Cite

Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG. Continuous distending pressure for respiratory distress in preterm infants. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002271. DOI: 10.1002/14651858.CD002271.

Author Information

  1. 1

    Penang Medical College, Department of Paediatrics, Penang, Malaysia

  2. 2

    Wanganui Hospital, Dept Paediatrics, Wanganui, New Zealand

  3. 3

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

  4. 4

    Royal Women's Hospital, Department of Obstetrics and Gynaecology, Carlton, Victoria, Australia

*Jacqueline J Ho, Department of Paediatrics, Penang Medical College, 4 Sepoy Lines, Penang, 10450, Malaysia. jho@pc.jaring.my.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 22 APR 2002

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Abstract

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

Background

Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm infants (Greenough 1998, Bancalari 1992). Intermittent positive pressure ventilation (IPPV) with surfactant is the standard treatment for the condition. The major difficulty with IPPV is that it is invasive, resulting in airway and lung injury and contributing to the development of chronic lung disease.

Objectives

To determine the effect of continuous distending pressure (CDP) on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress.

Search methods

The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2008), MEDLINE (1966 - February, 2008), and EMBASE (1980 - February 2008), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants, journal hand searching mainly in the English language.

Selection criteria

All trials using random or quasi-random allocation of preterm infants with respiratory distress were eligible. Interventions were continuous distending pressure including continuous positive airway pressure (CPAP) by mask, nasal prong, nasopharyngeal tube, or endotracheal tube, or continuous negative pressure (CNP) via a chamber enclosing the thorax and lower body, compared with standard care.

Data collection and analysis

Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by each author.

Main results

CDP is associated with a lower rate of failed treatment (death or use of assisted ventilation) [summary RR 0.65 (95% CI 0.52, 0.81), RD -0.20 (95% CI -0.29, -0.10), NNT 5 (95% CI 4, 10)], overall mortality [summary RR 0.52 (95% CI 0.32, 0.87), RD -0.15 (95% CI -0.26, -0.04), NNT 7 (95% CI 4, 25)], and mortality in infants with birth weights above 1500 g [summary RR 0.24 (95% CI 0.07, 0.84), RD -0.28 (95% CI -0.48, -0.08), NNT 4 (95% CI 2, 13)]. The use of CDP is associated with an increased rate of pneumothorax [summary RR 2.64 (95% CI 1.39, 5.04), RD 0.10 (95% CI 0.04, 0.17), NNH 17 (95% CI 17, 25)].

Authors' conclusions

In preterm infants with respiratory distress the application of CDP either as CPAP or CNP is associated with reduced respiratory failure and reduced mortality. CDP is associated with an increased rate of pneumothorax. Four out of six of these trials were done in the 1970's. Therefore, the applicability of these results to current practice is difficult to assess. Where resources are limited, such as in developing countries, CPAP for RDS may have a clinical role. Further research is required to determine the best mode of administration and the role of CDP in modern intensive care settings

 

Plain language summary

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

Continuous distending pressure for respiratory distress in preterm infants

Some benefits found in using continuous distending pressure (CDP) for respiratory distress syndrome in preterm babies.

Respiratory distress syndrome (RDS) is the most common cause of disease and death in babies born before 34 weeks gestation. Intermittent positive pressure ventilation (IPPV) is the standard way of helping these babies breathe. A simpler method of assisting breathing is to provide a continuous lung distending pressure - either no continuous positive pressure to the airway or continuous negative pressure (partial vacuum). The review of trials found that continuous distending pressure (CDP) reduces the rate of death or the need for assisted ventilation and reduced the need for IPPV. The small and mostly dated trials also found that CDP can increase the rate of pneumothorax (air outside the lung in the chest cavity).

 

摘要

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

背景

持續擴張壓治療早產兒呼吸窘迫症候群

呼吸窘迫症候群(RDS)是早產兒疾病與死亡的最重要單一原因(Greenough 1998, Bancalari 1992)。應用表面活性劑進行間歇正壓通氣(IPPV)是該病的標準治療法。 IPPV的主要困難是由於其侵入性,導致呼吸道和肺損傷,引發慢性肺部疾病。

目標

為確定持續擴張壓(CDP)是否減少患呼吸窘迫症候群但有自主呼吸的早產兒對IPPV的需要及所引起的疾病,且無不良反應。

搜尋策略

使用新生兒評價組的標準檢索策略進行檢索。檢索包括了牛津周產期試驗數據庫、Cochrane對照試驗中心註冊資料庫(Cochrane圖書館,2004年第3期)、MEDLINE(1966年至2004年8月)、EMBASE(1980年至2004年8月),以前的回顧包括交叉引用、摘要、會議與研討會論文集、專家信息,並主要對英語雜誌進行了視窗檢索。

選擇標準

所有使用隨機或半隨機法分配RDS早產兒的試驗均符合要求。介入方法為持續擴張壓,包括利用面罩、鼻翼管、鼻咽管或氣管插管進行連續氣道正壓(CPAP),或使用一個圍住胸部和下部身體的盒子進行連續負壓(CNP)與標準治療相比較。

資料收集與分析

每位作者應用Cochrane協作組織及其新生兒評價組的標準方法,包括獨立評估試驗品質和提取數據。

主要結論

CDP與治療失敗率降低(死亡或使用輔助通氣)[總RR 0.70 (0.55, 0.88), RD −0.22 (−0.35, −0.09), NNT 5 (3, 11)],總死亡率[總RR 0.52 (0.32, 0.87), RD −0.15 (−0.26, −0.04), NNT 7 (4, 25)],以及出生體重大於1500克嬰兒的死亡率降低[總RR 0.24 (0.07, 0.84), RD −0.281 (−0.483, −0.078), NNT 4 (2, 13)]有關聯。 CDP的使用與氣胸發病率增加[總RR 2.36 (1.25, 5.54), RD 0.14 (0.04, 0.23), NNH 7 (4, 24)]也有關聯。

作者結論

無論以CPAP或CNP方式應用CDP於呼吸窘迫症候群早產兒,對降低呼吸衰竭和減少死亡率是有益的。CDP與氣胸發生率增加有關聯。考慮到上世紀70年代重症照護的背景,5個試驗中就有4個是在當時進行的,要在當前實務對這些結果的應用進行評估是很困難的。在資源不足地區,如開發中國家,用CPAP治療呼吸窘迫症候群可在臨床上發揮作用。還需要進一步的研究確定治療的最佳模式及其在現代重症照護條件下的應用。

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

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

總結

利用持續擴張壓(CDP)治療早產嬰兒的呼吸窘迫症候群被發現是有益處的。呼吸窘迫症候群(RDS)是在34週前出生的嬰兒最常見的疾病和造成死亡的原因。間歇正壓通氣(IPPV)是幫助這些嬰兒呼吸標準的方式。一個協助呼吸簡單的方法,是在胸外提供持續肺擴張的壓力  無論是持續氣道正壓或連續負壓(部分真空)。在本試驗回顧發現,持續擴張壓(CDP)可降低死亡率或需要輔助通氣,需要IPPV的機會。過去一些小型的試驗也發現,CDP有不利的影響是會增加氣胸機率(空氣在胸腔內,肺以外地方)。