The role of 2 modes of mechanical ventilation for respiratory support in very low birth weight preterm infants with respiratory distress syndrome

doi:10.3877/cma.j.issn.1673-5250.2022.02.011

Objective

To explore the efficacy and safety of high frequency oscillatory ventilation (HFOV) and synchronized intermittent mandatory ventilation and pressure support ( SIMV+ PSV) in very low birth weight infants with respiratory distress syndrome (RDS).

Methods

Fifty very low birth weight preterm infants with RDS who failed after intubation-surfactant-extubation (InSurE) treatment at Chengdu Second People′s Hospital from October 2017 to October 2019 were enrolled. The random number table method was used to divide them into observation group (n=25, treated by HFOV ventilation mode) and control group (n=25, treated by SIMV+ PSV ventilation mode). A retrospective analysis was used to statistically analyze the following indexes between two groups: arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), oxygenation index (OI), duration of invasive ventilator support. In addition, the incidence of RDS complications such as intracranial hemorrhage, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), pneumonia and neonatal necrotizing enterocolitis (NEC) were statistically compared between 2 groups. Informed consent was obtained from guardians of each participant. The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013.

Results

① There were no significant differences between two groups in general clinical data, such as gender ratio, gestational age, birth weight, age and delivery mode (P>0.05). ②After 24 h of mechanical ventilation support, the PaCO₂ levels in observation group were significantly higher than those in control group [(90.2±13.8) mmHg vs (82.6±11.5) mmHg] (1 mmHg=0.133 kPa), PaCO₂ levels [(38.1±5.2) mmHg vs (46.5±6.1) mmHg], OI levels (10.6±2.7 vs 17.3±3.9) were significantly lower than those in control group, and the above differences were statistically significant (PaO₂: t=2.115, P=0.040; PaCO₂: t=5.240, P<0.001; OI: t=7.484, P<0.001). ③The duration of invasive ventilator support and hospital stay were shorter in observation group than those in control group [(82.6±7.3) h vs (93.7±8.9) h, (27.5±2.5) h vs (31.5±3.0) h], and the differences between two groups were statistically significant (t=4.822, 5.121; P<0.05). ④The duration of ventilator support for children with RDS grade Ⅱ, Ⅲ and Ⅳ in observation group was shorter than those in control group, respectively, and the above differences were statistically significant (P<0.05). ⑤ The complication rate of observation group was 4.0% (1/25), which was lower than 32.0% (8/25) of control group, and the difference was statistically significant (χ²=4.878, P<0.05).

Conclusions

Compared with SIMV+ PSV ventilation mode, HFOV can significantly improve the clinical symptoms and reduce the complication rate of very low birth weight preterm infants with RDS, which is a safe and effective ventilation mode for RDS.

Key words: High-frequency ventilation, Intermittent positive-pressure ventilation, Respiratory distress syndrome, newborn, Blood gas analysis, Infant, very low birth weight, Infant, newborn

表1 2组RDS极低出生体重早产儿一般临床资料比较

组别	例数	性别[例数(%)]		胎龄(周，±s)	出生体重(g，±s)	生后时间(h，±s)	分娩方式[例数(%)]^a
组别	例数	男	女	胎龄(周，±s)	出生体重(g，±s)	生后时间(h，±s)	剖宫产	自然分娩
观察组	25	14(13.5)	11(11.5)	29.1±1.7	1 346.8±15.7	22.6±2.3	11(11.5)	14(13.5)
对照组	25	13(13.5)	12(11.5)	29.9±2.5	1 354.6±14.5	21.6±2.1	12(11.5)	13(13.5)
检验值		χ²＝0.081		t＝1.323	t＝1.884	t＝1.638	χ²＝0.081
P值		0.777		0.192	0.067	0.108	0.777

表1 2组RDS极低出生体重早产儿一般临床资料比较

组别	例数	性别[例数(%)]		胎龄(周，±s)	出生体重(g，±s)	生后时间(h，±s)	分娩方式[例数(%)]^a
组别	例数	男	女	胎龄(周，±s)	出生体重(g，±s)	生后时间(h，±s)	剖宫产	自然分娩
观察组	25	14(13.5)	11(11.5)	29.1±1.7	1 346.8±15.7	22.6±2.3	11(11.5)	14(13.5)
对照组	25	13(13.5)	12(11.5)	29.9±2.5	1 354.6±14.5	21.6±2.1	12(11.5)	13(13.5)
检验值		χ²＝0.081		t＝1.323	t＝1.884	t＝1.638	χ²＝0.081
P值		0.777		0.192	0.067	0.108	0.777

表2 2组RDS极低出生体重早产儿PaO₂、PaCO₂、OI比较(±s)

组别	例数	PaO₂(mmHg)	PaCO₂(mmHg)	OI
观察组	25	90.2±13.8	38.1±5.2	10.6±2.7
对照组	25	82.6±11.5	46.5±6.1	17.3±3.9
t值		2.115	5.240	7.484
P值		0.040	<0.001	<0.001

表2 2组RDS极低出生体重早产儿PaO₂、PaCO₂、OI比较(±s)

组别	例数	PaO₂(mmHg)	PaCO₂(mmHg)	OI
观察组	25	90.2±13.8	38.1±5.2	10.6±2.7
对照组	25	82.6±11.5	46.5±6.1	17.3±3.9
t值		2.115	5.240	7.484
P值		0.040	<0.001	<0.001

表3 2组RDS极低出生体重早产儿机械通气治疗时间、住院时间比较(±s)

组别	例数	机械通气治疗时间(h)	住院时间(d)
观察组	25	82.6±7.3	27.5±2.5
对照组	25	93.7±8.9	31.5±3.0
t值		4.822	5.121
P值		<0.001	<0.001

表3 2组RDS极低出生体重早产儿机械通气治疗时间、住院时间比较(±s)

组别	例数	机械通气治疗时间(h)	住院时间(d)
观察组	25	82.6±7.3	27.5±2.5
对照组	25	93.7±8.9	31.5±3.0
t值		4.822	5.121
P值		<0.001	<0.001

表4 2组RDS Ⅱ级极低出生体重早产儿机械通气治疗时间比较(h，±s)

组别	例数	机械通气治疗时间
观察组	13	87.8±4.3
对照组	16	98.6±5.8
t值		—5.583
P值		<0.001

表4 2组RDS Ⅱ级极低出生体重早产儿机械通气治疗时间比较(h，±s)

组别	例数	机械通气治疗时间
观察组	13	87.8±4.3
对照组	16	98.6±5.8
t值		—5.583
P值		<0.001

表5 2组RDS Ⅲ级极低出生体重早产儿机械通气治疗时间比较(h，±s)

组别	例数	机械通气治疗时间
观察组	8	80.6±1.6
对照组	6	88.2±1.8
t值		—8.391
P值		<0.001

表5 2组RDS Ⅲ级极低出生体重早产儿机械通气治疗时间比较(h，±s)

组别	例数	机械通气治疗时间
观察组	8	80.6±1.6
对照组	6	88.2±1.8
t值		—8.391
P值		<0.001

表6 2组RDS Ⅳ级极低出生体重早产儿机械通气治疗时间比较(h，±s)

组别	例数	机械通气治疗时间
观察组	4	69.4±5.3
对照组	3	78.7±1.3
t值		—2.891
P值		0.034

表6 2组RDS Ⅳ级极低出生体重早产儿机械通气治疗时间比较(h，±s)

组别	例数	机械通气治疗时间
观察组	4	69.4±5.3
对照组	3	78.7±1.3
t值		—2.891
P值		0.034

表7 2组RDS极低出生体重早产儿机械通气治疗相关并发症发生率比较[例数(%)]

组别	例数	ROP	肺炎	NEC	合计
观察组	25	0(0)	1(4.0)	0(0)	1(4.0)
对照组	25	2(8.0)	4(16.0)	2(8.0)	8(32.0)
χ²值		—	—	—	4.878^a
P值		—	—	—	0.027

表7 2组RDS极低出生体重早产儿机械通气治疗相关并发症发生率比较[例数(%)]

组别	例数	ROP	肺炎	NEC	合计
观察组	25	0(0)	1(4.0)	0(0)	1(4.0)
对照组	25	2(8.0)	4(16.0)	2(8.0)	8(32.0)
χ²值		—	—	—	4.878^a
P值		—	—	—	0.027

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