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Cochrane Database of Systematic Reviews

同步机械通气在新生儿呼吸支持中的应用

Información

DOI:
https://doi.org/10.1002/14651858.CD000456.pub5Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 01 septiembre 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Neonatología

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Anne Greenough

    Correspondencia a: Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King’s College London, London, UK

    [email protected]

  • Thomas E Rossor

    Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King’s College London, London, UK

  • Adesh Sundaresan

    Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King’s College London, London, UK

  • Vadivelam Murthy

    Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King’s College London, London, UK

  • Anthony D Milner

    Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms in Asthma, King’s College London, London, UK

Contributions of authors

Professor Anne Greenough and Professor Anthony Milner have co‐authored all issues of this review.

Dr. Murthy coauthored this 2012 review update.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA

    Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201100016C

Declarations of interest

AG received no grants or speaker fees for the three years prior to the publication of this review.

TER has no interest to declare

AS has no interest to declare

VM has no interest to declare

ADM has no interest to declare

Acknowledgements

Dr. Murthy was supported by the Guy's and St Thomas' Charity Fund.

Version history

Published

Title

Stage

Authors

Version

2016 Sep 01

Synchronized mechanical ventilation for respiratory support in newborn infants

Review

Anne Greenough, Thomas E Rossor, Adesh Sundaresan, Vadivelam Murthy, Anthony D Milner

https://doi.org/10.1002/14651858.CD000456.pub5

2016 Aug 19

Synchronized mechanical ventilation for respiratory support in newborn infants

Review

Anne Greenough, Vadivelam Murthy, Anthony D Milner, Thomas E Rossor, Adesh Sundaresan

https://doi.org/10.1002/14651858.CD000456.pub4

2008 Jan 23

Synchronized mechanical ventilation for respiratory support in newborn infants

Review

Anne Greenough, Gabriel Dimitriou, Michael Prendergast, Anthony D Milner

https://doi.org/10.1002/14651858.CD000456.pub3

2004 Jul 19

Synchronized mechanical ventilation for respiratory support in newborn infants

Review

Anne Greenough, Anthony D Milner, Gabriel Dimitriou

https://doi.org/10.1002/14651858.CD000456.pub2

2001 Jan 22

Synchronized mechanical ventilation in neonates

Review

Anne Greenough, A D Milner, G Dimitriou

https://doi.org/10.1002/14651858.CD000456

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram: review update

Figuras y tablas -
Figure 1

Study flow diagram: review update

Comparison 1: HFPPV vs CMV, Outcome 1: Death

Figuras y tablas -
Analysis 1.1

Comparison 1: HFPPV vs CMV, Outcome 1: Death

Comparison 1: HFPPV vs CMV, Outcome 2: Air leaks

Figuras y tablas -
Analysis 1.2

Comparison 1: HFPPV vs CMV, Outcome 2: Air leaks

Comparison 1: HFPPV vs CMV, Outcome 3: Total air leak

Figuras y tablas -
Analysis 1.3

Comparison 1: HFPPV vs CMV, Outcome 3: Total air leak

Comparison 1: HFPPV vs CMV, Outcome 4: BPD (oxygen dependency at 28 days)

Figuras y tablas -
Analysis 1.4

Comparison 1: HFPPV vs CMV, Outcome 4: BPD (oxygen dependency at 28 days)

Comparison 1: HFPPV vs CMV, Outcome 5: IVH

Figuras y tablas -
Analysis 1.5

Comparison 1: HFPPV vs CMV, Outcome 5: IVH

Comparison 2: ACV/SIMV vs CMV, Outcome 1: Death

Figuras y tablas -
Analysis 2.1

Comparison 2: ACV/SIMV vs CMV, Outcome 1: Death

Comparison 2: ACV/SIMV vs CMV, Outcome 2: Air leaks

Figuras y tablas -
Analysis 2.2

Comparison 2: ACV/SIMV vs CMV, Outcome 2: Air leaks

Comparison 2: ACV/SIMV vs CMV, Outcome 3: Duration of ventilation (hours)

Figuras y tablas -
Analysis 2.3

Comparison 2: ACV/SIMV vs CMV, Outcome 3: Duration of ventilation (hours)

Comparison 2: ACV/SIMV vs CMV, Outcome 4: Extubation failure

Figuras y tablas -
Analysis 2.4

Comparison 2: ACV/SIMV vs CMV, Outcome 4: Extubation failure

Comparison 2: ACV/SIMV vs CMV, Outcome 5: Severe IVH

Figuras y tablas -
Analysis 2.5

Comparison 2: ACV/SIMV vs CMV, Outcome 5: Severe IVH

Comparison 2: ACV/SIMV vs CMV, Outcome 6: BPD (oxygen dependency at 28 days)

Figuras y tablas -
Analysis 2.6

Comparison 2: ACV/SIMV vs CMV, Outcome 6: BPD (oxygen dependency at 28 days)

Comparison 2: ACV/SIMV vs CMV, Outcome 7: Moderate/Severe BPD (oxygen dependent at 36 weeks PCA)

Figuras y tablas -
Analysis 2.7

Comparison 2: ACV/SIMV vs CMV, Outcome 7: Moderate/Severe BPD (oxygen dependent at 36 weeks PCA)

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 1: Death

Figuras y tablas -
Analysis 3.1

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 1: Death

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 2: BPD: oxygen requirement at 28 days

Figuras y tablas -
Analysis 3.2

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 2: BPD: oxygen requirement at 28 days

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 3: Moderate/ Severe BPD: Oxygen requirement at 36 weeks PCA

Figuras y tablas -
Analysis 3.3

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 3: Moderate/ Severe BPD: Oxygen requirement at 36 weeks PCA

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 4: Death or BPD

Figuras y tablas -
Analysis 3.4

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 4: Death or BPD

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 5: Duration of mechanical ventilation

Figuras y tablas -
Analysis 3.5

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 5: Duration of mechanical ventilation

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 6: Air leaks

Figuras y tablas -
Analysis 3.6

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 6: Air leaks

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 7: IVH Grade 3/4

Figuras y tablas -
Analysis 3.7

Comparison 3: SIMV or SIMV + PS vs HFOV, Outcome 7: IVH Grade 3/4

Comparison 4: ACV vs SIMV, Outcome 1: Duration of weaning (hours)

Figuras y tablas -
Analysis 4.1

Comparison 4: ACV vs SIMV, Outcome 1: Duration of weaning (hours)

Comparison 4: ACV vs SIMV, Outcome 2: Weaning failure

Figuras y tablas -
Analysis 4.2

Comparison 4: ACV vs SIMV, Outcome 2: Weaning failure

Comparison 4: ACV vs SIMV, Outcome 3: Extubation failure

Figuras y tablas -
Analysis 4.3

Comparison 4: ACV vs SIMV, Outcome 3: Extubation failure

Comparison 4: ACV vs SIMV, Outcome 4: Air leaks

Figuras y tablas -
Analysis 4.4

Comparison 4: ACV vs SIMV, Outcome 4: Air leaks

Comparison 5: PS + SIMV versus SIMV, Outcome 1: Death

Figuras y tablas -
Analysis 5.1

Comparison 5: PS + SIMV versus SIMV, Outcome 1: Death

Comparison 5: PS + SIMV versus SIMV, Outcome 2: Air leaks

Figuras y tablas -
Analysis 5.2

Comparison 5: PS + SIMV versus SIMV, Outcome 2: Air leaks

Comparison 5: PS + SIMV versus SIMV, Outcome 3: BPD

Figuras y tablas -
Analysis 5.3

Comparison 5: PS + SIMV versus SIMV, Outcome 3: BPD

Comparison 5: PS + SIMV versus SIMV, Outcome 4: Severe IVH (grade III and IV)

Figuras y tablas -
Analysis 5.4

Comparison 5: PS + SIMV versus SIMV, Outcome 4: Severe IVH (grade III and IV)

Comparison 6: PRVCV vs SIMV, Outcome 1: Death prior to discharge

Figuras y tablas -
Analysis 6.1

Comparison 6: PRVCV vs SIMV, Outcome 1: Death prior to discharge

Comparison 6: PRVCV vs SIMV, Outcome 2: BPD: oxygen requirement at 36 weeks in survivors

Figuras y tablas -
Analysis 6.2

Comparison 6: PRVCV vs SIMV, Outcome 2: BPD: oxygen requirement at 36 weeks in survivors

Comparison 6: PRVCV vs SIMV, Outcome 3: Air leak

Figuras y tablas -
Analysis 6.3

Comparison 6: PRVCV vs SIMV, Outcome 3: Air leak

Comparison 6: PRVCV vs SIMV, Outcome 4: Severe IVH

Figuras y tablas -
Analysis 6.4

Comparison 6: PRVCV vs SIMV, Outcome 4: Severe IVH

Comparison 7: PSV vs SIMV, Outcome 1: Duration of weaning

Figuras y tablas -
Analysis 7.1

Comparison 7: PSV vs SIMV, Outcome 1: Duration of weaning

Comparison 7: PSV vs SIMV, Outcome 2: Extubation failure

Figuras y tablas -
Analysis 7.2

Comparison 7: PSV vs SIMV, Outcome 2: Extubation failure

Comparison 7: PSV vs SIMV, Outcome 3: Air leaks (total)

Figuras y tablas -
Analysis 7.3

Comparison 7: PSV vs SIMV, Outcome 3: Air leaks (total)

Comparison 7: PSV vs SIMV, Outcome 4: Moderate/Severe BPD: oxygen requirement at 36 weeks PCA

Figuras y tablas -
Analysis 7.4

Comparison 7: PSV vs SIMV, Outcome 4: Moderate/Severe BPD: oxygen requirement at 36 weeks PCA

Duration of weaning

Study

Participants

Duration of weaning ACV (Median (range))

Duration of weaning PSV (Median(range))

Significance

Patel 2012

36

34 (7‐100)

27 (10‐169)

p=0.88

Figuras y tablas -
Analysis 8.1

Comparison 8: ACV versus PSV, Outcome 1: Duration of weaning

Comparison 1. HFPPV vs CMV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Death Show forest plot

4

647

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.61, 1.00]

1.2 Air leaks Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.2.1 Pneumothorax

3

585

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.51, 0.93]

1.2.2 Pulmonary interstitial emphysema

1

137

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.49, 0.94]

1.3 Total air leak Show forest plot

1

62

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.06, 1.08]

1.4 BPD (oxygen dependency at 28 days) Show forest plot

4

647

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.77, 1.46]

1.5 IVH Show forest plot

1

62

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.02, 0.94]

Figuras y tablas -
Comparison 1. HFPPV vs CMV
Comparison 2. ACV/SIMV vs CMV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Death Show forest plot

6

1790

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.94, 1.47]

2.2 Air leaks Show forest plot

7

1830

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.76, 1.27]

2.3 Duration of ventilation (hours) Show forest plot

5

1463

Mean Difference (IV, Fixed, 95% CI)

‐38.30 [‐53.90, ‐22.69]

2.4 Extubation failure Show forest plot

4

1056

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.68, 1.28]

2.5 Severe IVH Show forest plot

6

1790

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.73, 1.40]

2.6 BPD (oxygen dependency at 28 days) Show forest plot

4

805

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.75, 1.12]

2.7 Moderate/Severe BPD (oxygen dependent at 36 weeks PCA) Show forest plot

2

1310

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.75, 1.08]

Figuras y tablas -
Comparison 2. ACV/SIMV vs CMV
Comparison 3. SIMV or SIMV + PS vs HFOV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Death Show forest plot

4

996

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.91, 1.71]

3.2 BPD: oxygen requirement at 28 days Show forest plot

1

110

Risk Ratio (M‐H, Fixed, 95% CI)

3.21 [0.37, 27.83]

3.3 Moderate/ Severe BPD: Oxygen requirement at 36 weeks PCA Show forest plot

3

869

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [1.07, 1.65]

3.4 Death or BPD Show forest plot

1

356

Risk Ratio (M‐H, Fixed, 95% CI)

2.38 [1.41, 4.03]

3.5 Duration of mechanical ventilation Show forest plot

2

466

Mean Difference (IV, Fixed, 95% CI)

1.89 [1.04, 2.74]

3.6 Air leaks Show forest plot

3

1398

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.70, 1.19]

3.6.1 Pulmonary interstitial emphysema

1

498

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.44, 0.99]

3.6.2 Pneumothorax

3

900

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.82, 1.64]

3.7 IVH Grade 3/4 Show forest plot

4

1010

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.71, 1.24]

Figuras y tablas -
Comparison 3. SIMV or SIMV + PS vs HFOV
Comparison 4. ACV vs SIMV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Duration of weaning (hours) Show forest plot

3

120

Mean Difference (IV, Fixed, 95% CI)

‐42.38 [‐94.35, 9.60]

4.2 Weaning failure Show forest plot

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.31, 1.93]

4.3 Extubation failure Show forest plot

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.37, 2.67]

4.4 Air leaks Show forest plot

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.23, 2.83]

4.4.1 Total air leaks

3

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.23, 2.83]

Figuras y tablas -
Comparison 4. ACV vs SIMV
Comparison 5. PS + SIMV versus SIMV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Death Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1.1 Death during first 28 days

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.08, 2.01]

5.1.2 Death prior to discharge

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.31, 2.43]

5.2 Air leaks Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.2.1 Pneumothorax

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

Not estimable

5.2.2 Pulmonary interstitial emphysema

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.25, 2.15]

5.3 BPD Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.3.1 BPD (oxygen dependency at 28 days)

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.84, 1.23]

5.3.2 Moderate/Severe BPD (oxygen dependency at 36 weeks PMA)

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.42, 1.18]

5.4 Severe IVH (grade III and IV) Show forest plot

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.41, 2.08]

Figuras y tablas -
Comparison 5. PS + SIMV versus SIMV
Comparison 6. PRVCV vs SIMV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Death prior to discharge Show forest plot

1

211

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.50, 2.11]

6.2 BPD: oxygen requirement at 36 weeks in survivors Show forest plot

1

185

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.55, 1.27]

6.3 Air leak Show forest plot

1

424

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.51, 2.13]

6.3.1 PIE

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

1.66 [0.56, 4.91]

6.3.2 Pneumothorax

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.26, 1.88]

6.4 Severe IVH Show forest plot

1

203

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.29, 1.58]

Figuras y tablas -
Comparison 6. PRVCV vs SIMV
Comparison 7. PSV vs SIMV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Duration of weaning Show forest plot

1

60

Mean Difference (IV, Fixed, 95% CI)

‐11.30 [‐26.53, 3.93]

7.2 Extubation failure Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.57, 2.07]

7.3 Air leaks (total) Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.01, 4.00]

7.4 Moderate/Severe BPD: oxygen requirement at 36 weeks PCA Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.46, 2.17]

Figuras y tablas -
Comparison 7. PSV vs SIMV
Comparison 8. ACV versus PSV

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

8.1 Duration of weaning Show forest plot

1

Other data

No numeric data

Figuras y tablas -
Comparison 8. ACV versus PSV