Intervention Review

Neuromuscular paralysis for newborn infants receiving mechanical ventilation

  1. Filip Cools1,*,
  2. Martin Offringa2

Editorial Group: Cochrane Neonatal Group

Published Online: 20 APR 2005

Assessed as up-to-date: 21 JUL 2009

DOI: 10.1002/14651858.CD002773.pub2


How to Cite

Cools F, Offringa M. Neuromuscular paralysis for newborn infants receiving mechanical ventilation. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002773. DOI: 10.1002/14651858.CD002773.pub2.

Author Information

  1. 1

    Universitair Ziekenhuis Brussel, Neonatology, Brussels, Belgium

  2. 2

    Academic Medical Center, Pediatrics, H3-144, Amsterdam, Netherlands

*Filip Cools, Neonatology, Universitair Ziekenhuis Brussel, Laarbeekaan 101, Brussels, 1090, Belgium. Filip.Cools@uzbrussel.be.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 APR 2005

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Abstract

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

Background

Ventilated newborn infants breathing in asynchrony with the ventilator are potentially exposed to more severe barotrauma and are at risk for complications such as pneumothorax or intraventricular haemorrhage. Neuromuscular paralysis, which eliminates the spontaneous breathing efforts of the infant, creates complete synchronization with the ventilator and may minimize these risks. However, complications have been reported with prolonged neuromuscular paralysis in newborn infants.

Objectives

To determine whether routine neuromuscular paralysis compared with no routine paralysis results in clinically important benefits or harms in newborn infants receiving mechanical ventilation.

Search methods

The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2009), MEDLINE (from 1966 to January 2009), EMBASE (from 1988 to January 2009) and Cinahl (from 2005 - January 2009) were searched. References of review articles were hand searched.

Selection criteria

All trials using random or quasi-random patient allocation in which the use of neuromuscular blocking agents during mechanical ventilation were compared to no paralysis or selective paralysis in newborn infants.

Data collection and analysis

Data were abstracted using standard methods of the Cochrane Collaboration and its Neonatal Review Group, with independent evaluation of trial quality and abstraction and synthesis of data by both review authors. Treatment effect was analysed using relative risk, risk difference and weighted mean difference.

Main results

Ten possibly eligible trials were identified, of which six were included in the review. All the included trials studied preterm infants ventilated for respiratory distress syndrome and used pancuronium as the neuromuscular blocking agent. In the analysis of the results of all trials, no significant difference was found in mortality, air leak or chronic lung disease. There was a significant reduction in intraventricular haemorrhage and a trend towards less severe intraventricular haemorrhages. In the subgroup analysis of trials studying a selected population of ventilated infants with evidence of asynchronous respiratory effort, a significant reduction in intraventricular haemorrhage (any grade and severe IVH) was found, and a trend towards less air leak. In the subgroup analysis of trials studying an unselected population of ventilated infants, no significant differences were found for any of the outcomes.

Authors' conclusions

For ventilated preterm infants with evidence of asynchronous respiratory effort, neuromuscular paralysis with pancuronium seems to have a favourable effect on intraventricular haemorrhage and possibly on pneumothorax. However, uncertainty remains regarding the long-term pulmonary and neurologic effects and the safety of prolonged use of pancuronium in ventilated newborn infants. There is no evidence from randomised trials on the effects of neuromuscular blocking agents other than pancuronium. The routine use of pancuronium or any other neuromuscular blocking agent in ventilated newborn infants cannot be recommended based on current evidence.

 

Plain language summary

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

Neuromuscular paralysis for newborn infants receiving mechanical ventilation

Long-term effects of muscle paralysing drugs on newborns needing mechanical ventilation are as yet unclear.

When newborn infants develop breathing difficulties, they need mechanical ventilation to help them breathe. Sometimes they do not breathe in rhythm with the ventilator but 'fight' the ventilator, causing bleeding in the brain or serious lung injuries. Treating distress or pain caused by the ventilator and adjusting the ventilator to the infant's own breathing pattern can help. Paralysing newborn infants with muscle relaxing drugs such as pancuronium also stops them fighting the ventilator. However, the review of trials found that, although there seems to be some advantage regarding bleeding in the brain, long term effects of this method are not clear. More research is needed.

 

摘要

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

背景

神經肌肉麻痺用於需要機械式呼吸的新生兒

使用呼吸器的新生兒若呼吸與呼吸器不同步易發生機械式呼吸的併發症,如:氣胸或是腦室內出血,並且暴露於較嚴重的氣壓傷害,因而導致臨床預後不佳。神經肌肉麻痺可減少嬰兒自發性呼吸使力,對這方面有潛在的好處,然而肌肉鬆弛使用在嬰兒曾被報告有許多的併發症,因此新生兒長期使用神經肌肉麻痺的安全性仍存有許多擔憂。

目標

比較常規將使用呼吸器的新生兒實行神經肌肉痲痺與不常規實行神經肌肉麻痺,在臨床上重要的好處與害處。

搜尋策略

搜尋The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2004) 、MEDLINE (1966年到2004年4月) 和EMBASE (從 1988年到2004年4月) ,以手動搜尋回顧性文章的參考文獻,並且沒有加入語言限制。

選擇標準

所有的試驗將病人利用隨機或半隨機方式分配,將新生兒在機械式呼吸期間常規接受神經肌肉拮抗劑,與不給予麻痺或是選擇性給予麻痺相比較,研究方法的品質由兩位作者分開分別評估。

資料收集與分析

資料以Cochrane Collaboration及當中Neonatal Review Group的標準方法做摘要,分別評估試驗品質,資料的選取及組成由兩位作者負責,治療效果用相對危險性、危險差以及加權平均差異分析。

主要結論

發現有十個可能合格的試驗,其中六個包含在這篇回顧性文章中,被包含的試驗皆研究因呼吸窘迫症候群且需要呼吸器的早產兒,並使用pancuronium作為神經肌肉阻斷劑。分析所有試驗的結果,對於死亡率、氣漏或是慢性肺疾病並沒有顯著差異,但是對於腦室內出血的發生有顯著的減少以及腦室內出血有較不嚴重的趨勢;在某一小族群的試驗是選擇性研究使用呼吸器並有不同步的呼吸努力的嬰兒,發現有顯著的減少腦室出血 (任何程度和嚴重的腦室出血) ,並有較少氣漏的趨勢;另一小族群的試驗是非選擇性的研究所有使用呼吸器的嬰兒,並沒有發現結果有任何顯著的差異。

作者結論

對於使用呼吸器並有不同步呼吸努力的早產兒,接受pancuronium使神經肌肉麻痺似乎對腦室內出血及可能對氣漏有較佳的作用,然而對於長期肺部和神經學的作用和pancuronium長期用於使用呼吸器的新生兒的安全性仍有不確定。沒有任何隨機性試驗提到pancuronium以外其他神經肌肉阻斷劑的功效,現今並沒有證據建議常規使用pancuronium或其他神經肌肉阻斷劑在使用呼吸器的新生兒。

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

肌肉麻痺的藥物使用在需要機械式換氣的新生兒的長期效果還不清楚。當新生兒有呼吸困難,需要機械式換氣幫助他們呼吸,有時他們呼吸沒有依呼吸器的節律呼吸而反抗呼吸器,導致腦內出血或是嚴重肺部傷害。治療呼吸器造成的不適及痛苦、調整呼吸器與嬰兒的自呼模式一致可以有所助益,用肌肉鬆弛劑如pancuronium使嬰兒麻痺也可使他們不會反抗呼吸器。然而回顧這些試驗發現,雖然對於腦內出血這方面似乎有好處,這種方法的長期作用並不清楚,需要更多的研究。