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. 2002;2002(2):CD002973.
doi: 10.1002/14651858.CD002973.

Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants

M W Davies  1 , P G Woodgate
Affiliations

Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants

M W Davies et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: Tracheal gas insufflation (TGI) is a technique where a continuous flow of gas is instilled into the lower trachea during conventional mechanical ventilation. TGI can improve carbon dioxide removal with lower ventilation pressures and smaller tidal volumes, potentially decreasing secondary lung injury and chronic lung disease (CLD).

Objectives: To assess whether, in mechanically ventilated neonates, the use of tracheal gas insufflation reduces mortality, CLD and other adverse clinical outcomes without significant side effects.

Search strategy: Searches were made of MEDLINE 1966 to December 2001, CINAHL 1982 to December 2001, the Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2001) and conference and symposia proceedings.

Selection criteria: Randomised controlled trials (RCT) that include newborn infants who are mechanically ventilated, and compare TGI during conventional mechanical ventilation (CMV) with CMV alone. Primary outcomes - mortality, CLD and neurodevelopmental outcome; secondary outcomes - air leak, intraventricular haemorrhage, periventricular leukomalacia, duration of mechanical ventilation, duration of respiratory support, duration of oxygen therapy, duration of hospital stay, retinopathy of prematurity, immediate adverse effects.

Data collection and analysis: Each reviewer assessed eligibility, trial quality and extracted data separately. Study authors were contacted for additional information if necessary.

Main results: Only one small study was found to be eligible. This study found no evidence of effect on mortality, CLD or age at first extubation. The total duration of ventilation was 9.3 days shorter in the TGI group (95% CI from 15.7 to 2.9 days shorter). The age at complete weaning from ventilation was 26 days shorter in the TGI group (95% CI from 46 to 6 days shorter). There was no evidence of effect on the total duration of respiratory support, oxygen therapy or hospital stay.

Reviewer's conclusions: There is evidence from a single RCT that TGI may reduce the duration of mechanical ventilation in preterm infants - although the data from this small study do not give sufficient evidence to support the introduction of TGI into clinical practice. The technical requirements for performing TGI (as performed in the single included study) are great. There is no statistically significant reduction in the total duration of respiratory support or hospital stay. TGI cannot be recommended for general use at this time.

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Conflict of interest statement

Nil

Figures

1.1
1.1. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 1 Mortality before day 28.
1.2
1.2. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 2 Mortality before discharge.
1.3
1.3. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 3 In oxygen at day 28 in survivors to 28 days.
1.4
1.4. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 4 In oxygen at 36 weeks corrected GA in survivors to 36 weeks corrected GA.
1.5
1.5. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 5 Death or CLD at 28 days.
1.6
1.6. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 6 Death or CLD at 36 weeks corrected GA.
1.7
1.7. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 7 Pneumothorax.
1.8
1.8. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 8 Endotracheal tube obstruction.
1.9
1.9. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 9 Intraventricular haemorrhage (any) in survivors to 28 days.
1.10
1.10. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 10 Intraventricular haemorrhage (grade 3+) in survivors to 28 days.
1.11
1.11. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 11 Periventricular leukomalacia in survivors to 28 days.
1.12
1.12. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 12 Pulmonary interstitial emphysema among babies examined.
1.13
1.13. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 13 Retinopathy of prematurity (any) among babies examined.
1.14
1.14. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 14 Retinopathy of prematurity (grade 3+) among babies examined.
1.15
1.15. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 15 Need for re‐intubation because of ETT obstruction in babies where data are available.
1.16
1.16. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 16 Need for re‐intubation for any reason other than ETT obstruction in babies where data are available.
1.17
1.17. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 17 One or more episodes of severe hypocapnia (PaCO2 <25 mmHg) in babies where data are available.
1.18
1.18. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 18 One or more episodes of severe hypercapnia (PaCO2 >70 mmHg) in babies where data are available.
1.19
1.19. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 19 Time to first extubation (days) in survivors to 28 days.
1.20
1.20. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 20 Total duration of ventilation until remains extubated for 7 consecutive days (days) in survivors to 28 days.
1.21
1.21. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 21 Age at complete weaning from ventilation ‐ IPPV or HFO (days) in survivors to discharge.
1.22
1.22. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 22 Age at complete weaning from respiratory support ‐ ventilation or CPAP (days) in survivors to discharge.
1.23
1.23. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 23 Age at complete weaning from oxygen (days) in survivors to discharge.
1.24
1.24. Analysis
Comparison 1 Continuous TGI during conventional mechanical ventilation (CMV) vs CMV alone, Outcome 24 Duration of hospital stay (days) in survivors to discharge.
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References

References to studies included in this review

Dassieu 2000 {published data only}
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Wald 2005 {published data only}
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References to other published versions of this review

Davies 2002
    1. Davies MW, Woodgate PG. Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD002973] - DOI - PMC - PubMed

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