Analysis Of Treatment Effect With Severe Respiratory Failure Of Severe Newborn Respiratory Distress Syndrome

BackgroundSevere Respiratory Failure of Severe Newborn Respiratory Distress Syndrome（NRDS）is more common at neonatology.Conventional Mechanical Ventilation（CMV）is not completely effective for treatment of Severe Respiratory Failure of NRDS.The treatment of Inhaled Nitric Oxide（iNO）is applicable for neonates with hypoxic respiratory failure,but it is contraindicated in methemoglo-binemia or bleeding.High Frequent Oscillation Ventilation（HFOV）is common used for severe treatment of respiratory failure caused by parenchymal lung disease,but it may lead to Intraventricular Hemorrhage when low lung volume.iNO or HFOV both can be in treatment of respiratory failure,but each has limitations.ObjectiveTo compare the efficacy and safety between HFOV and Conventional CMV combined with iNO in treatment of Severe Respiratory Failure of Severe NRDS.The ventilator therapy time,Oxygenation Index,length of stay,mortality,failure rates and complication rates and so on were observed and compared between the 2 methods,in order to improve the treatment level and accumulate clinical experiences.MethodsData of 67 Severe Respiratory Failure of severe NRDS from January of 2014 to August of 2015 in the People’s Hospital of Dehong Prefecture in Yunnan Province were retrospectively analyzed.The patients were divided into HFOV group（n=35）and iNO group（n=32）.The comparison was performed in follows:（1）the main indexes: the ventilator therapy time and Oxygenation Index（OI）;（2）the second indexes: total length of stay,mortality,failure rate,the Inspired Oxygen（FiO₂）,Mean Airway Pressure（MAP）,Arterial Partial Pressure of Oxygen（PaO₂）and Partial Pressure of Arterial Carbon Dioxide（PaCO₂）at 0h,8h,16 h and 24 h after mechanical ventilation treatment,and the incidence rates of the Pulmonary Air Leaks,Bronchopulmonary Dysplasia（BPD）,Intraventricular Hemorrhage（IVH）,infection,pneumorrhagia,RetiNOpathy Of Prematurity（ROP）,Patent Ductus Arteriosus（PDA）,Necrotizing Enterocolitis（NEC）,Periventricular Leukomalacia（PVL）as well as the Endotracheal Sputum Bolt.ResultsThere was no difference in the general data between the two groups（P>0.05）.The ventilator therapy time of iNO group was shorter than that of the HFOV group,and there was a significant difference（P<0.05）.There was no difference in total length of stay,mortality,failure rate between the two groups（P>0.05）.There was no difference in complications between the two groups（P>0.05）.As for the five parameters of FiO₂,MAP,PaO₂,PaCO₂ and OI,each of them had no significant difference at 0h（P>0.05）.As the time went on,the changes of each parameter were inclined to the favorable effective treatment result.The differences in each index after repeated measurements at different time points of different groups had statistical significance（P< 0.05）.As for parameters of FiO₂,MAP and OI,there was no significant difference between the two groups（P>0.05）.The improvement of PaO₂ in iNO group was faster than that of the HFOV group,and there was a significant difference（P<0.05）.The declination of PaCO₂ was faster in HFOV group than that of the iNO group,and there was a significant difference（P<0.05）.ConclusioniNO had shorter ventilator therapy time in treatment of Severe Respiratory Failure of severe NRDS.HFOV and iNO are both effective for Severe Respiratory Failure of severe NRDS,iNO can better improve the PaO₂,while HFOV can better improve the PaCO₂.There’s no difference in others items between the two groups.When Oxygenation is not good,CMV+iNO is appropriate,while HFOV is suggested for those with methemoglobinemia.