Ventilação Oscilatória de Alta Frequência em Neonatologia e Pediatria: uma revisão sistemática
High Frequency Oscillatory Ventilation in Neonatology and Pediatrics: a systematic review
Pedro Ykaro Fialho Silva, Mayara Fabiana Pereira Costa, Ingrid Fonsêca Damasceno Bezerra, Ana Caryne Xenofonte Matias, Silvana Alves Pereira
Resumo
Introdução: A Ventilação Oscilatória de Alta Frequência (VOAF) tem sua eficácia discutida, ao longo dos anos. Existem lacunas na recomendação sobre sua utilização, nas diversas afecções do sistema respiratório, em neonatologia e pediatria. Objetivo: Verificar as principais indicações e repercussões da VOAF, comparadas à ventilação mecânica convencional, nas variáveis respiratórias de recém-nascidos e crianças. Métodos: Foram realizadas, buscas nas bases de dados eletrônicas PubMED e MEDLINE. A seleção dos artigos foi realizada por dois revisores, considerando os ensaios clínicos randomizados, publicados entre os anos de 2014 e 2018, na língua inglesa, com escore PEDro maior que 4, texto completo disponível na íntegra, que abordassem as indicações e repercussões da VOAF em recém-nascidos e crianças. Resultados: Foram incluídos, nove estudos. No que se refere às doenças que resultavam na indicação da VOAF, prevaleceu a síndrome do desconforto respiratório (SDR), tanto na população neonatal quanto na população pediátrica. As variáveis mais estudadas foram as respostas da oxigenação, incluindo índice de oxigenação, pressão parcial de oxigênio, níveis de fração inspirada de oxigênio e níveis de pressão parcial de gás carbônico. Nos estudos que abordaram a VOAF não invasiva, o principal desfecho avaliado foi a necessidade de ventilação mecânica invasiva. Conclusão: A VOAF apresentou resultados superiores, em relação às variáveis de oxigenação, na síndrome do desconforto respiratório moderada a grave, na modalidade invasiva.
Palavras-chave
Abstract
Introduction: High-Frequency Oscillatory Ventilation (HFOV) has its effectiveness discussed over the years. The recommendation of its use in the various respiratory diseases in neonatology and paediatrics is controversial. Objective: To verify the main indications and repercussions of HFOV compared to conventional mechanical ventilation in the respiratory variables of newborns and children. Methods: Searches were performed in the electronic databases PubMed and MEDLINE. The selection of articles was performed by two reviewers, evaluating the randomized clinical trials published between 2014 and 2018, in English, with PEDro score greater than 4, full text available, that addressed HFOV indications and repercussions in newborns and children. Results: 9 studies were included. Regarding the diseases resulted in the indication of HFOV, respiratory distress syndrome (RDS) prevailed, both in the neonatal and pediatric population. The most studied variables were oxygenation responses, including oxygenation index, partial oxygen pressure, levels of inspired oxygen fraction and partial pressure levels of carbon dioxide. In studies addressed non-invasive HFOV, the main outcome assessed was the need for invasive mechanical ventilation. Conclusion: HFOV presented superior results concerning the oxygenation variables in moderate to severe respiratory distress syndrome in invasive modality
Keywords
Referências
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