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Solunum Sıkıntısı Sendromunda Daha Az İnvazif Sürfaktan Verme Tekniklerinin Karşılaştırılması

Year 2020, Volume: 10 Issue: 4, 493 - 498, 30.12.2020
https://doi.org/10.16899/jcm.712931

Abstract

Giriş: Bu çalışmada; RDS’li bebeklerde yeni geliştirilen ve daha az invaziv surfaktan uygulama yöntemlerinin (ince kateter yöntemi ve INSURE) etkinliğini değerlendirmesi ve bu yöntemlerin birbiriyle karşılaştırılması amaçlandı.

Gereç ve Yöntem: Spontan soluyan ve surfaktan ihtiyacı olan 685-2100 gr arasında 15 hasta çalışmaya alındı. Hastaların 7’sine ince kateter yöntemi, 8’ine ise INSURE yöntemi ile surfaktan uygulandı.

Bulgular: Hastaların doğum şekli, kilo, cinsiyeti, prenatal öyküleri, steroid kullanımları, APGAR skorları ve hasta taburcu edilinceye kadar tüm veriler kaydedildi. Minimal invaziv sürfaktan tedavisi uygulanan grupta %71 (5/7), INSURE uygulanan grupta %87,5 (7/8) 3-4 dakika süren desaturasyon ve bradikardi gözlendi. INSURE grubunda 8 hastanın 4’ ünde bradikardi gözlendi ve pozitif basınçlı ventilasyona ihtiyaç duyuldu. Entübasyon-Sürfaktan-Ekstübasyon grubundan 3 hasta hayatını kaybetti; 15 hastanın birinde, ROP gelişti ve bu hasta da INSURE uygulanan gruptaydı. Gruplar arasında, MV’de kalış süresi ve mortalitede istatistiksel açıdan anlamlı idi (p<0.01). Hastanede kalış süresi ve O2 ihtiyaç süreleri arasında farklılığın olmadığı belirlendi
(P<0.05). İnce kateter yönteminde mekanik ventilatörde kalış süresi vemortalite oranları daha düşük olarak belirlendi (p<0.05).

Sonuç: Spontan soluyan ve surfaktan ihtiyacı olan prematüre bebekler surfaktan tedavisi için entübe edilmesine gerek yoktur. Uygulanan her iki yöntem surfaktan verilişi açısından uygundur. Bu çalışmada entübe edilmeden surfaktan uygulama metotları içerisinde, hasta sonuçları açısından en uygun ve başarılı metotun ince kateter yöntemi olduğu sonucuna varıldı.

References

  • Referans1. Hamvas A. Pathophysiology and management of respiratory distress syndrome. Fanaroff & Martın’s Neonatal Perinatal Medicine 9th. edition, Elsevier Mosby, 2011:1075-116.
  • Referans2. Gallimore V. The report of the Australian and New Zealand Neonatal Network, 2007.
  • Referans3. Fuchs H, Lindner W, Leiprecht A, Mendler MR, Hummler HD. Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of <29 weeks gestational age. Arch Dis Child Fetal Neonatal Ed 2011; 96: 343-347.
  • Referans4. Ammari A, Suri M, Milisavljevic V, Sahni R, Bateman D, Sanocka U, et al. variables associated with the early failure of nasal CPAP in very loe birth weight infants. J Pediatr 2005; 147: 341-347.
  • Referans5. De Jaegere AP, Lee JH, Cante C, Kaam AH. Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation. Acta Paediatr 2011; 101: 374-379.
  • Referans6. Kribs A, Pillekamp F, Hünseler C, Vierzig A, Roth B. Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ≤27 weeks). Paediatr Anaesth 2007; 17: 364–369.
  • Referans7. Dargaville PA, Aiyappan A, Cornelius A, Williams C, De Paoli AG. Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed 2011; 96: 243-248.
  • Referans8. Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubaltelli FF. Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants<30 weeks’ gestation. Pediatrics 2004; 113: 560–563.
  • Referans9. Oxford Network DRM Study Group Diantha Howard, Karla Ferrelli, Jeanette O'Conor, Roger F. Soll and for the Vermont Michael S. Dunn, Joseph Kaempf, Alan de Klerk, Rose de Klerk, Maureen Reilly. Management of Preterm Neonates Randomized Trial Comparing 3 Approaches to the Initial Respiratory, Pediatrics 2011; 168; e1069.
  • Referans10. Rojas MA, Lozano JM, Rojas MX, Laughon M, Bose CL, Rondon MA, et al. Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics 2009; 123: 137-142.
  • Referans11. Kanmaz G, Erdeve Ö, Canpolat FE, Mutlu B, Dilmen U. Surfactant Administration via thin catheter during spontaneous breathing: randomized controlled trial. Am Pediatrics 2013; 131: 502 -509.
  • Referans12. Dargaville PA, Aiyappan A, De Paoli AG, Kuschel CA, Kamlin CO, Carlin JB, et all. Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2013; 98: 122-126.
  • Referans13. Ramanathan R, Bhatia J.J, Sekar K, Ernst FR. Mortality in preterm infants with respiratory distress syndrome treated with poractant alfa, calfactant or beractant: a retrospective study. J Perinatol. Feb 2013; 33: 119–125.
  • Referans14. Kribs A, Roll C, Göpel W, Wieg C, Groneck P, Laux R, Vochem M. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatrics. 2015; 169(8): 723-730. doi:10.1001/jamapediatrics.2015.0504
  • Referans15. Isayama, T, Iwami H, McDonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. Jama. 2016; 316(6): 611-624.
  • Referans16. Härtel C, Paul P, Hanke K, Humberg A, Kribs A, Mehler K, Göpel W. Less invasive surfactant administration and complications of preterm birth. Scientific reports. 2018; 8(1): 8333.
  • Referans17. Dumpa V & Bhandari V. Surfactant, steroids and non-invasive ventilation in the prevention of BPD. In Seminars in perinatology. 2018, October. WB Saunders.
  • Referans18. Rigo V, Lefebvre C, Broux I. Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis. European journal of pediatrics.2016; 175(12): 1933-1942.
  • Referans19. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, te Pas A, Speer CP. European consensus guidelines on the management of respiratory distress syndrome–2019 update. Neonatology. 2019; 15(4): 432-450.

Comparison Of Less Invasive Surfactant Delivery Techniques In Respiratory Distress Syndrome

Year 2020, Volume: 10 Issue: 4, 493 - 498, 30.12.2020
https://doi.org/10.16899/jcm.712931

Abstract

Background: This study was conducted to evaluate and compare the effectiveness of newly developed minimal invasive methods for surfactant administration (LISA by using Magill forceps, INSURE)
Methods: The research was conducted on 15 patients between 685-2100 gr weight, requiring surfactant administration. Poractant alpha, dose 200 mg/kg, was administered to patients with spontaneous breathing on continuous positive airway pressure support. LISA was used to administer surfactant to 7 of 15 patients, whereas 8 of them had surfactant administered using the INSURE method.
Results: The data regarding the delivery method, birth weight, gender, prenatal history, usage of steroids, APGAR scores and other data about the patients until hospital discharge were recorded. Desaturation and bradycardia for 3-4 minutes were observed in 71% (5/7) of LISA and 87.5% (7/8) of INSURE cases. Bradycardia was observed in 4 of 8 patients from the INSURE group and positive ventilation was needed. From the INSURE group, 3 patients died; one of 15 had ROP and this patient was from the INSURE group. No difference was found among the groups regarding required duration of O2 and days of hospital stay (p<0.05). The thin catheter group had significantly fewer median days on mechanical ventilation and lower rate of mortality (p<0.05).
Conclusions: When there is no need for mechanical ventilation, intubation for surfactant administration was determined not to be necessary in the present study. LISA was observed to be the best method for surfactant administration among the methods without intubation.

References

  • Referans1. Hamvas A. Pathophysiology and management of respiratory distress syndrome. Fanaroff & Martın’s Neonatal Perinatal Medicine 9th. edition, Elsevier Mosby, 2011:1075-116.
  • Referans2. Gallimore V. The report of the Australian and New Zealand Neonatal Network, 2007.
  • Referans3. Fuchs H, Lindner W, Leiprecht A, Mendler MR, Hummler HD. Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of <29 weeks gestational age. Arch Dis Child Fetal Neonatal Ed 2011; 96: 343-347.
  • Referans4. Ammari A, Suri M, Milisavljevic V, Sahni R, Bateman D, Sanocka U, et al. variables associated with the early failure of nasal CPAP in very loe birth weight infants. J Pediatr 2005; 147: 341-347.
  • Referans5. De Jaegere AP, Lee JH, Cante C, Kaam AH. Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation. Acta Paediatr 2011; 101: 374-379.
  • Referans6. Kribs A, Pillekamp F, Hünseler C, Vierzig A, Roth B. Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ≤27 weeks). Paediatr Anaesth 2007; 17: 364–369.
  • Referans7. Dargaville PA, Aiyappan A, Cornelius A, Williams C, De Paoli AG. Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed 2011; 96: 243-248.
  • Referans8. Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubaltelli FF. Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants<30 weeks’ gestation. Pediatrics 2004; 113: 560–563.
  • Referans9. Oxford Network DRM Study Group Diantha Howard, Karla Ferrelli, Jeanette O'Conor, Roger F. Soll and for the Vermont Michael S. Dunn, Joseph Kaempf, Alan de Klerk, Rose de Klerk, Maureen Reilly. Management of Preterm Neonates Randomized Trial Comparing 3 Approaches to the Initial Respiratory, Pediatrics 2011; 168; e1069.
  • Referans10. Rojas MA, Lozano JM, Rojas MX, Laughon M, Bose CL, Rondon MA, et al. Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics 2009; 123: 137-142.
  • Referans11. Kanmaz G, Erdeve Ö, Canpolat FE, Mutlu B, Dilmen U. Surfactant Administration via thin catheter during spontaneous breathing: randomized controlled trial. Am Pediatrics 2013; 131: 502 -509.
  • Referans12. Dargaville PA, Aiyappan A, De Paoli AG, Kuschel CA, Kamlin CO, Carlin JB, et all. Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2013; 98: 122-126.
  • Referans13. Ramanathan R, Bhatia J.J, Sekar K, Ernst FR. Mortality in preterm infants with respiratory distress syndrome treated with poractant alfa, calfactant or beractant: a retrospective study. J Perinatol. Feb 2013; 33: 119–125.
  • Referans14. Kribs A, Roll C, Göpel W, Wieg C, Groneck P, Laux R, Vochem M. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatrics. 2015; 169(8): 723-730. doi:10.1001/jamapediatrics.2015.0504
  • Referans15. Isayama, T, Iwami H, McDonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. Jama. 2016; 316(6): 611-624.
  • Referans16. Härtel C, Paul P, Hanke K, Humberg A, Kribs A, Mehler K, Göpel W. Less invasive surfactant administration and complications of preterm birth. Scientific reports. 2018; 8(1): 8333.
  • Referans17. Dumpa V & Bhandari V. Surfactant, steroids and non-invasive ventilation in the prevention of BPD. In Seminars in perinatology. 2018, October. WB Saunders.
  • Referans18. Rigo V, Lefebvre C, Broux I. Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis. European journal of pediatrics.2016; 175(12): 1933-1942.
  • Referans19. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, te Pas A, Speer CP. European consensus guidelines on the management of respiratory distress syndrome–2019 update. Neonatology. 2019; 15(4): 432-450.
There are 19 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Yasemin Çoban 0000-0002-5283-239X

Erdal Taşkın 0000-0001-6387-1741

Publication Date December 30, 2020
Acceptance Date September 13, 2020
Published in Issue Year 2020 Volume: 10 Issue: 4

Cite

AMA Çoban Y, Taşkın E. Comparison Of Less Invasive Surfactant Delivery Techniques In Respiratory Distress Syndrome. J Contemp Med. December 2020;10(4):493-498. doi:10.16899/jcm.712931