European Consensus Guidelines on the Management of Respiratory Distress Syndrome-2019 Update
European Consensus Guidelines on the Management of Respiratory Distress Syndrome-2019 Update
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DOI：
10.1159/000499361
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发表时间：
2019-01-01
期刊：
影响因子：
2.5
通讯作者：
Halliday, Henry L.
中科院分区：
文献类型：
--
作者：
Sweet, David G.;Carnielli, Virgilio;Halliday, Henry L.
随着呼吸窘迫综合征（RDS）管理的进步，临床医生必须不断修改他们目前的做法。我们报告了欧洲经验丰富的产科医生和围产期产科专家小组根据截至2018年底的现有文献对“欧洲RDS管理指南”进行的第四次更新。RDS婴儿的最佳结局包括预测早产的风险，需要适当的产妇转移到围产期中心和产前及时使用类固醇。产房管理已变得更加以证据为基础，肺保护方案，包括开始CPAP和氧气滴定，应在出生后立即实施。表面活性物质替代治疗是RDS管理的关键部分，其使用的新协议建议早期管理和避免机械通气。维持婴儿非侵入性呼吸支持的方法已经得到进一步发展，可能会减少痛苦并减少慢性肺部疾病。随着机械通气技术的改进，导致肺损伤的风险应该会降低，尽管使用咖啡因和必要时使用产后类固醇的机械通气时间最小化也是重要的考虑因素。优化RDS婴儿的一般护理方案也是必不可少的，良好的体温控制、仔细的液体和营养管理、维持灌注和明智地使用抗生素都是最佳结局的重要决定因素。(c)2019 S. Karger AG，巴塞尔
As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of "European Guidelines for the Management of RDS" by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome. (c) 2019 S. Karger AG, Basel