Less Invasive Surfactant Administration: A Viewpoint.
Less Invasive Surfactant Administration: A Viewpoint.
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DOI：
10.1055/a-2001-9139
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发表时间：
2024-01
影响因子：
2
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中科院分区：
文献类型：
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治疗早产儿呼吸窘迫综合征的标准治疗是经鼻持续气道正压通气或持续气道正压通气与外源性表面活性物质替代的联合呼吸支持。气管插管是表面活性剂给药的常规方法，是一种与手术和机械通气并发症相关的侵入性手术。INSURE（插管、表面活性剂给药和术后立即拔管）技术是一种公认的方法，旨在减少与机械通气相关的短期并发症和长期发病率，但不能消除与气管插管和机械通气相关的风险。可以克服与INSURE技术相关的问题的表面活性剂递送的替代方法是通过喉罩的表面活性剂、通过细气管内导管的表面活性剂和使用喷雾器递送的雾化表面活性剂。在过去的二十年中研究的表面活性剂输送的三种替代方法具有优点和局限性。十多项随机对照试验旨在研究与INSURE作为对照组相比，表面活性剂输送的三种替代技术的益处，在降低死亡率、机械通气需求和支气管肺发育不良方面取得了可喜的结果。需要找到一种侵入性较小的表面活性剂给药技术是一个临床相关的问题。在常规临床实践中广泛采用之前，应确定三种替代策略中最有益的技术。本文旨在总结目前的证据，使用三种替代技术的表面活性剂管理的新生儿，比较三种技术，突出的知识差距，并提出未来的发展方向。 关键点需要找到一种侵入性较小的替代方法的表面活性剂输送是一个临床相关的问题。研究替代表面活性剂递送方法的临床试验已显示出有希望的结果，但对于更广泛地采用到临床实践中尚无定论。未来的研究应探索新的临床试验方法，并选择临床显著的长期结果进行比较。
The standard of care in treating respiratory distress syndrome in preterm infants is respiratory support with nasal continuous positive airway pressure or a combination of continuous positive airway pressure and exogenous surfactant replacement. Endotracheal intubation, the conventional method for surfactant administration, is an invasive procedure associated with procedural and mechanical ventilation complications. The INSURE (intubation, surfactant administration, and extubation soon after) technique is an accepted method aimed at reducing the short-term complications and long-term morbidities related to mechanical ventilation but does not eliminate risks associated with endotracheal intubation and mechanical ventilation. Alternative methods of surfactant delivery that can overcome the problems associated with the INSURE technique are surfactant through a laryngeal mask, surfactant through a thin intratracheal catheter, and aerosolized surfactant delivered using nebulizers. The three alternative methods of surfactant delivery studied in the last two decades have advantages and limitations. More than a dozen randomized controlled trials have aimed to study the benefits of the three alternative techniques of surfactant delivery compared with INSURE as the control arm, with promising results in terms of reduction in mortality, need for mechanical ventilation, and bronchopulmonary dysplasia. The need to find a less invasive surfactant administration technique is a clinically relevant problem. Before broader adoption in routine clinical practice, the most beneficial technique among the three alternative strategies should be identified. This review aims to summarize the current evidence for using the three alternative techniques of surfactant administration in neonates, compare the three techniques, highlight the knowledge gaps, and suggest future directions. Key Points The need to find a less invasive alternative method of surfactant delivery is a clinically relevant problem. Clinical trials that have studied alternative surfactant delivery methods have shown promising results but are inconclusive for broader adoption into clinical practice. Future studies should explore novel clinical trial methodologies and select clinically significant long term outcomes for comparison.
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