Yenidoğan pnömonisinin yönetiminde non-invaziv ventilasyon yöntemlerinin karşılaştırmalı etkinliği: bir klinik sonlanım çalışması

Year 2024, Volume: 49 Issue: 4, 1057 - 1066, 30.12.2024

Aybüke Yazıcı , Sevim Ünal

https://doi.org/10.17826/cumj.1559564

Abstract

Amaç: Bu çalışmada alt solunum yolu enfeksiyonu (ASYE) tanısı konulan yenidoğanlarda noninvaziv ventilasyon (NMV) yöntemlerinin etkinliğini ve sonuçlarını karşılaştırmayı amaçladık.
Gereç ve Yöntem: Yenidoğan yoğun bakım ünitesinde yüksek akışlı nazal kanül (HFNC), nazal sürekli pozitif hava yolu basıncı (NCPAP) veya nazal aralıklı pozitif basınçlı ventilasyon (NIPPV) ile tedavi edilen ASYE’lu yenidoğanlarda prospektif bir çalışma yürütüldü. Yöntemin başarısızlığı, klinik ve laboratuvar bulgularına göre 6 saat içinde başka bir NIV yöntemine geçmek olarak tanımlandı. Gruplar klinik ve laboratuvar bulguları, hastanede kalış süresi, sonuçlar, başarı oranları ve komplikasyonlar açısından karşılaştırıldı.
Bulgular: Çalışmaya medyan gebelik yaşı 38 hafta ve doğum ağırlığı 2991±673 g olan toplam 106 yenidoğan dahil edildi. Kabuldeki Downes skorları NCPAP grubunda diğerlerinden anlamlı olarak daha yüksekti. HFNC grubunda kan pH ve CO2 seviyelerinde daha iyi sonuçlar saptanmasına rağmen daha yüksek oranda tedavi başarısızlığı görüldü. NCPAP en yüksek başarı oranıyla (%86.8) ilişkiliydi, bunu NIPPV (%78.7) ve HFNC (%52.4) izledi. NCPAP ve NIPPV ile başarılı bir şekilde tedavi edilen hastaların hastanede kalış süreleri daha kısaydı. Lojistik regresyon analizine göre NIPPV HFNC ile karşılaştırıldığında başarısızlık riskini anlamlı şekilde azalttı.
Sonuç: NIPPV ve NCPAP, daha kısa hastane yatışıyla neonatal ASYE'nu yönetmede HFNC'den daha etkiliydi. Neonatal ASYE’nda, HFNC bazal solunum parametrelerini stabilize etmede etkili olabilir.

Keywords

Yüksek akışlı nazal kanül, alt solunum yolu enfeksiyonu, nazal CPAP, nazal IPPV, yenidoğan, non-invaziv ventilasyon

Comparative efficacy of non-invasive ventilation methods in managing neonatal pneumonia: a clinical outcome study

Abstract

Purpose: The aim of this study was was to compare the effectiveness and outcomes of non-invasive ventilation (NIV) methods in neonates diagnosed with lower respiratory tract infections (LRTI).
Materials and Methods: A prospective study was conducted in neonates with LRTI treated with high-flow nasal cannula (HFNC), nasal continuous positive airway pressure (NCPAP), or nasal intermittent positive pressure ventilation (NIPPV) in the neonatal intensive care unit. Method failure was defined as switching to another NIV method within 6 hours based on clinical and laboratory findings. The groups were compared for clinical and laboratory findings, length of hospital stay, outcomes, success rates, and complications.
Results: One hundred and six neonates were included with a median gestational age of 38 weeks and birth weight of 2991±673 g. Downes scores at admission were significantly higher in the NCPAP group than in the others. The HFNC group had better of blood pH and CO2 levels but had a higher rate of treatment failure. NCPAP was associated with the highest success rate (86.8%), followed by NIPPV (78.7%) and HFNC (52.4%). The length of hospital stay was shorter in patients successfully treated with NCPAP and NIPPV. According to the logistic regression analysis, NIPPV significantly reduced the risk of failure compared to HFNC.
Conclusion: NIPPV and NCPAP were more effective than HFNC in the management of neonatal LRTI with shorter hospital stay. HFNC may be effective in stabilizing baseline respiratory parameters in the management of neonatal LRTI.

Keywords

Newborn, lower respiratory tract infection, non-invasive ventilation, high-flow nasal cannula, nasal CPAP, nasal IPPV.

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