Masks versus prongs as interfaces for nasal continuous positive airway pressure in preterm infants

被引:11
作者
Prakash, Raj [1 ]
De Paoli, Antonio G. [2 ]
Oddie, Sam J. [3 ]
Davis, Peter G. [4 ,5 ,6 ]
McGuire, William [7 ]
机构
[1] NHS Trust, York & Scarborough Teaching Hosp, York, N Yorkshire, England
[2] Royal Hobart Hosp, Dept Paediat, Hobart, Tas, Australia
[3] Bradford Teaching Hosp NHS Fdn Trust, Bradford Neonatol, Bradford, W Yorkshire, England
[4] Royal Womens Hosp, Newborn Res Ctr & Neonatal Serv, Melbourne, Vic, Australia
[5] Murdoch Childrens Res Inst, Melbourne, Vic, Australia
[6] Univ Melbourne, Dept Obstet & Gynecol, Melbourne, Vic, Australia
[7] Univ York, Ctr Reviews & Disseminat, York, N Yorkshire, England
来源
COCHRANE DATABASE OF SYSTEMATIC REVIEWS | 2022年 / 11期
基金
英国医学研究理事会;
关键词
RANDOMIZED CONTROLLED-TRIAL; FLOW DRIVER; RESPIRATORY SUPPORT; BINASAL PRONGS; CPAP; BIRTH; EXTUBATION; MANAGEMENT; DISADVANTAGES; PREMATURITY;
D O I
10.1002/14651858.CD015129
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Nasal masks and nasal prongs are used as interfaces for providing continuous positive airway pressure (CPAP) for preterm infants with or at risk of respiratory distress, either as primary support aHer birth or as ongoing support aHer endotracheal extubation from mechanical ventilation. It is unclear which type of interface is associated with lower rates of CPAP treatment failure, nasal trauma, or mortality and other morbidity. Objectives To assess the benefits and harms of nasal masks versus nasal prongs for reducing CPAP treatment failure, nasal trauma, or mortality and other morbidity in newborn preterm infants with or at risk of respiratory distress. Search methods We used standard, extensive Cochrane search methods. The latest search date was October 2021. Selection criteria We included randomised controlled trials comparing masks versus prongs as interfaces for delivery of nasal CPAP in newborn preterm infants (less than 37 weeks' gestation) with or at risk of respiratory distress. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were 1. treatment failure, 2. all-cause mortality, and 3. neurodevelopmental impairment. Our secondary outcomes were 4. pneumothorax, 5. moderate-severe nasal trauma, 6. bronchopulmonary dysplasia, 7. duration of CPAP use, 8. duration of oxygen supplementation, 9. duration of hospitalisation, 10. patent ductus arteriosus receiving medical or surgical treatment, 11. necrotising enterocolitis, 12. severe intraventricular haemorrhage, and 13. severe retinopathy of prematurity. We used the GRADE approach to assess the certainty of the evidence. Main results We included 12 trials with 1604 infants. All trials were small (median number of participants 118). The trials occurred aHer 2001 in care facilities internationally, predominantly in India (eight trials). Most participants were preterm infants of 26 to 34 weeks' gestation who received nasal CPAP as the primary form of respiratory support aHer birth. The studied interfaces included commonly used commercially available masks and prongs. Lack of measures to blind caregivers or investigators was a potential source of performance and detection bias in all the trials. Meta-analyses suggested that use of masks compared with prongs may reduce CPAP treatment failure (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.58 to 0.90; 8 trials, 919 infants; low certainty). The type of interface may not aKect mortality prior to hospital discharge (RR 0.83, 95% CI 0.56 to 1.22; 7 trials, 814 infants; low certainty). There are no data on neurodevelopmental impairment. Meta-analyses suggest that the choice of interface may result in little or no diKerence in the risk of pneumothorax (RR 0.93, 95% CI 0.45 to 1.93; 5 trials, 625 infants; low certainty). Use of masks rather than prongs may reduce the risk of moderate-severe nasal injury (RR 0.55, 95% CI 0.44 to 0.71; 10 trials, 1058 infants; low certainty). The evidence is very uncertain about the eKect on bronchopulmonary dysplasia (RR 0.69, 95% CI 0.46 to 1.03; 7 trials, 843 infants; very low certainty). Authors' conclusions The available trial data provide low-certainty evidence that use of masks compared with prongs as the nasal CPAP interface may reduce treatment failure and nasal injury, and may have little or no eKect on mortality or the risk of pneumothorax in newborn preterm infants with or at risk of respiratory distress. The eKect on bronchopulmonary dysplasia is very uncertain. Large, high-quality trials would be needed to provide evidence of suKicient validity and applicability to inform policy and practice.
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页数:55
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