课件：呼吸治疗肺保护.pptVIP

Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants Two trials involving 269 newborn infants no evidence ↓the incidence of death or CLD at 36 weeks (RR 0.94, 95% CI 0.78, 1.15) no evidence ↑IVH 3 or 4 (RR 0.84, 95% CI 0.54, 1.31) no evidence ↑PVL (RR 1.02, 95% CI 0.49, 2.12). no evidence ↑Long term neurodevelopmental outcomes One trial reported that permissive hypercapnia reduced the incidence of CLD in the 501 to 750 gram subgroup Cochrane Database Syst Rev. 2001;(2):CD002061 Permissive hypercapnia in neonates: the case of the good, the bad, and the ugly PaCO2 levels of 45-55 mmHg in high-risk neonates are safe and well tolerated Pediatr Pulmonol. 2002 Jan;33(1):56-64 高频震荡通气 High-frequency oscillatory ventilation High-frequency oscillatory ventilation for acute respiratory distress syndrome in adult patients 148 randomized, controlled trial ARDS HFOV PCV PaO2/FiO2 16h (p=0.008) 72h no Thirty-day mortality 37% or 52% (p=0.102) barotrauma, hemodynamic instability, or mucus plugging no different clinical use in adults FiO260% and MAP?20 cm H2O or PEEP15 cm H2O Crit Care Med. 2003 Apr;31(4 Suppl):S317-23 Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants updated in May 2003 3275 Randomized controlled trials comparing HFOV and CV in preterm or low birth weight infants with pulmonary dysfunction no evidence of effect on CLD and mortality at 28-30 days Pre-specified subgroup analyses ?Short term neurological morbidity ?Grade 3 or 4 IVH and PVL (no using high volume strategy) Cochrane Database Syst Rev. 2003(4):CD000104 Open lung ventilation improves gas exc