Randomised controlled trial of respiratory system compliance measurements in mechanically ventilated neonates

摘要

AIM—To determine whether outcomes of neonatalmechanical ventilation could be improved by regular pulmonary function testing.
METHODS—Two hundred and forty five neonates,without immediately life threatening congenital malformations, weremechanically ventilated in the newborn period. Infants were randomlyallocated to conventional clinical management (control group) orconventional management supplemented by regular measurements of staticrespiratory system compliance, using the single breath technique, withstandardised management advice based on the results.
RESULTS—Fifty five (45%) infants in each groupexperienced one or more adverse outcomes. The median (quartile)durations of ventilation and oxygen supplementation were 5 (2-12) and6 (2-34) days for the control group, and 4 (2-9) and 6 (3-36) daysfor the experimental group (not significant). On post-hoc secondaryanalysis, control group survivors were ventilated for 1269 days with amedian (quartile) of 5 (2-13) days, and experimental group survivorswere ventilated for 775 days with a median (quartile) duration of 3 (2-8) days (p=0.03).
CONCLUSIONS—Although primary analysis did not showany substantial benefit associated with regular measurement of staticrespiratory system compliance, this may reflect a type II error, and amoderate benefit has not been excluded. Larger studies are required toestablish the value of on-line monitoring techniques now available with neonatal ventilators.