Mechanical ventilation of newborn infants with severe lung disease results in reduced mortality. Mechanical ventilation with intermittent positive or negative pressure was introduced in the 1960s. It was compared with standard treatment in five trials for infants with very severe lung disease and resulted in a reduction in mortality. This effect was observed principally in infants with birth weights over two kilograms. Mechanical ventilation has become standard therapy for severe respiratory failure. There have been no trials in modern neonatal intensive care units so the magnitude of the benefits and harms in current practice are not known.
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Wprowadzenie
Mechanical ventilation (MV) for critically ill neonates was introduced in the 1960s and is now standard treatment for infants with severe RDS. However, the degree to which this made a contribution to the outcome of such infants is uncertain.
Cele
To evaluate the effects of the use of MV compared with no MV on mortality and morbidity in newborn infants with severe respiratory failure due to pulmonary disease.
Metody wyszukiwania badań
Searches of the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were updated in March 2010. Searches were also carried out of the Oxford Database of Perinatal Trials and for abstracts published by the Society for Pediatric Research (1967 to 2004 inclusive) and the European Society for Pediatric Research (1970 to 2004 inclusive).
Kryteria doboru badań
Randomised or quasi-randomised controlled trials in newborn infants with respiratory failure due to pulmonary disease evaluating the use of MV versus standard neonatal care without MV.
Zbieranie i analiza danych
The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used.
Główne wyniki
The five eligible trials reported on a total of 359 infants with RDS. Overall the risk of any reported mortality was less frequent in the MV group (summary RR 0.86, 95% CI 0.74, 1.00; RD -0.10, 95% CI -0.20, -0.01; NNT 10, 95% CI 5, 100). In infants with a birth weight of 1 to 2 kg, no significant difference in mortality was found (summary RR 0.86, 95% CI 0.70, 1.07). In infants with a birth weight of more than 2 kg there was a significant reduction in mortality with MV (summary RR 0.67, 95%CI 0.52, 0.87).
Any IVH at autopsy was not significantly different between the groups in any study or overall in four studies reporting on 202 infants who had an autopsy. Pneumothorax was reported in two studies of 275 infants and there is a non-significant trend towards an increase in the mechanical ventilation group (summary RR 2.75, 95% CI 0.72, 10.45).
Wnioski autorów
When MV was introduced in the 1960s to treat infants with severe respiratory failure due to pulmonary disease, trials showed an overall reduction in mortality which was most marked in infants born with a birthweight of more than 2 kg. This review does not provide information to evaluate the relative benefits or harms of MV in the setting of modern perinatal care.
