无创高频振荡通气在早产儿呼吸支持中的临床应用
收稿日期: 2023-08-21
网络出版日期: 2023-10-08
基金资助
国家重点研发计划(2022YFC2704805)
Clinical application of non-invasive high-frequency oscillatory ventilation in premature infants
Received date: 2023-08-21
Online published: 2023-10-08
无创高频振荡通气（noninvasive high-frequency oscillatory ventilation， NHFOV）是通过持续气流产生气道压力并在自主呼吸上叠加一定频率振荡的新型无创通气模式。NHFOV结合了高频通气的不需要同步、高效清除二氧化碳和经鼻持续气道正压通气（nasal continuous positive airway pressure，NCPAP）的无创接口、增加功能残气量改善氧合两者的优点。作为突破无创通气瓶颈的新模式，NHFOV在早产儿呼吸支持的临床应用逐渐增加。目前NHFOV应用没有统一的规范标准，取决于当地新生儿重症监护病房（neonatal intensive care unit，NICU）的惯例和方便。文章对NHFOV作用机制、适应证、呼吸机设备、无创接口、参数设置以及临床循证医学证据进行总结。
朱兴旺 , 史源 . 无创高频振荡通气在早产儿呼吸支持中的临床应用[J]. 临床儿科杂志, 2023 , 41(10) : 641 -645 . DOI: 10.12372/jcp.2023.23e0789
Noninvasive high-frequency oscillatory ventilation(NHFOV) is based on the application of a continuous flow, generating a constant distending positive pressure with superimposed oscillations, delivered all over the spontaneous breathing cycle. NHFOV matches together the advantages of high-frequency ventilation (no need for synchronisation, high efficacy in removing CO2) and nasal continuous positive airway pressure (NCPAP, non-invasive interface, increase in functional residual capacity allowing oxygenation to improve). As it represents another “brick in the wall” of the non-invasive respiratory support, it has been increasing applied in neonatal intensive care unit (NICU). At present, there is no consensus guidelines on the application of NHFOV, the application of NHFOV is largely based on the local practices and comfort. This article summarizes the physiology of NHFOV, indications, ventilator device, interfaces, parameter settings, and clinical evidence based on a PubMed literature search.
| [1] | De Luca D, Dell’Orto V. Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(6): F565-F570. |
| [2] | Fisher HS, Bohlin K, Bührer C, et al. Nasal high-frequency oscillation ventilation in neonates: a survey in five European countries[J]. Eur J Pediatr, 2015, 174(4): 465-471. |
| [3] | Mukerji A, Finelli M, Belik J. Nasal high-frequency oscillations for lung carbon dioxide clearance in the newborn[J]. Neonatology, 2013, 103(3): 161-165. |
| [4] | Hadj-Ahmed MA, Samson N, Nadeau C, et al. Laryngeal muscle activity during nasal high-frequency oscillatory ventilation in nonsedated newborn lambs[J]. Neonatology, 2015, 107(3): 199-205. |
| [5] | 中华医学会儿科学分会新生儿学组. 早产儿无创呼吸支持临床应用建议[J]. 中华儿科杂志, 2018, 56(9): 643-647. |
| [6] | De Luca D, Costa R, Visconti F, et al. Oscillation transmission and volume delivery during face mask-delivered HFOV in infants: bench and in vivo study[J]. Pediatr Pulmonol, 2016, 51(7): 705-712. |
| [7] | De Luca D, Carnielli VP, Conti G, et al. Noninvasive high frequency oscillatory ventilation through nasal prongs: bench evaluation of efficacy and mechanics[J]. Intensive Care Med, 2010, 36(12): 2094-2100. |
| [8] | Fischer C, Bertelle V, Hohlfeld J, et al. Nasal trauma due to continuous positive airway pressure in neonates[J]. Arch Dis Child Fetal Neonatal Ed, 2010, 95(6): F447-F451. |
| [9] | De Jaegere A, van Veenendaal MB, Michiels A, et al. Lung recruitment using oxygenation during open lung high-frequency ventilation in preterm infants[J]. Am J Respir Crit Care Med, 2006, 174(6): 639-645. |
| [10] | De Luca D, Piastra M, Pietrini D, et al. Effect of amplitude and inspiratory time in a bench model of non-invasive HFOV through nasal prongs[J]. Pediatr Pulmonol, 2012, 47(10): 1012-1018. |
| [11] | van der Hoeven M, Brouwer E, Blanco CE. Nasal high frequency ventilation in neonates with moderate respiratory insuf?ciency[J]. Arch Dis Child Fetal Neonatal Ed, 1998, 79(1): F61-F63. |
| [12] | Colaizy TT, Younis UM, Bell EF, et al. Nasal high-frequency ventilation for premature infants[J]. Acta Paediatr, 2008, 97(11): 1518-1522. |
| [13] | Czernik C, Schmalisch G, Bührer C, et al. Weaning of neonates from mechanical ventilation by use of nasopharyngeal high-frequency oscillatory ventilation: a preliminary study[J]. J Matern Fetal Neonatal Med, 2012, 25(4): 374-378. |
| [14] | Chen L, Wang L, Ma J, et al. Nasal high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome and ARDS after extubation: a randomized controlled trial[J]. Chest, 2019, 155(4): 740-748. |
| [15] | Seth S, Saha B, Saha AK, et al. Nasal HFOV versus nasal IPPV as a post-extubation respiratory support in preterm infants-a randomised controlled trial[J]. Eur J Pediatr, 2021, 180(10): 3151-3160. |
| [16] | Zhu X, Qi H, Feng Z, et al. Noninvasive high-frequency oscillatory ventilation vs nasal continuous positive airway pressure vs nasal intermittent positive pressure ventilation as postextubation support for preterm neonates in China: a randomized clinical trial[J]. JAMA Pediatr, 2022, 176(6): 551-559. |
| [17] | Zhu X, Li F, Shi Y, et al. Effectiveness of nasal continuous positive airway pressure vs nasal intermittent positive pressure ventilation vs noninvasive high-frequency oscillatory ventilation as support after extubation of neonates born extremely preterm or with more severe respiratory failure: a secondary analysis of a randomized clinical trial[J]. JAMA Netw Open, 2023, 6(7): e2321644. |
| [18] | Mukerji A, Singh B, Helou SE, et al. Use of noninvasive high-frequency ventilation in the neonatal intensive care unit: a retrospective review[J]. Am J Perinatol, 2015, 32(2): 171-176. |
| [19] | 王陈红, 施丽萍, 马晓路, 等. 无创高频振荡通气模式在极低出生体重儿呼吸支持中的应用[J]. 中华儿科杂志, 2017, 55(3): 177-181. |
| [20] | Zhu XW, Zhao JN, Tang SF, et al. Noninvasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with moderate-severe respiratory distress syndrome: a preliminary report[J]. Pediatr Pulmonol, 2017, 52(8): 1038-1042. |
| [21] | Iranpour R, Armanian AM, Abedi AR, et al. Nasal high-frequency oscillatory ventilation (nHFOV) versus nasal continuous positive airway pressure (NCPAP) as an initial therapy for respiratory distress syndrome (RDS) in preterm and near-term infants[J]. BMJ Paediatr Open, 2019, 3(1): e000443. |
| [22] | Malakian A, Bashirnezhadkhabaz S, Aramesh MR, et al. Noninvasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial[J]. J Matern Fetal Neonatal Med, 2020, 33(15): 2601-2607. |
| [23] | Mukerji A, Sarmiento K, Lee B, et al. Non-invasive high-frequency ventilation versus bi-phasic continuous positive airway pressure (BP-CPAP) following CPAP failure in infants <1250 g: a pilot randomized controlled trial[J]. J Perinatol, 2017, 37(1): 49-53. |
| [24] | Zhu X, Feng Z, Liu C, et al. Nasal high-frequency oscillatory ventilation in preterm infants with moderate respiratory distress syndrome: a multicenter randomized clinical trial[J]. Neonatology, 2021, 118(3): 325-331. |
| [25] | Li J, Chen L, Shi Y. Nasal high-frequency oscillatory ventilation versus nasal continuous positive airway pressure as primary respiratory support strategies for respiratory distress syndrome in preterm infants: a systematic review and meta-analysis[J]. Eur J Pediatr, 2022, 181(1): 215-223. |
/
| 〈 |
|
〉 |
沪公网安备 31011002000392号
