Second course of systemic dexamethasone: efficacy and respiratory function changes
Second course of systemic dexamethasone: efficacy and respiratory function changes
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DOI：
10.1080/14767058.2020.1752653
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发表时间：
2020-04-14
影响因子：
1.8
通讯作者：
Greenough, Anne
中科院分区：
文献类型：
--
作者：
Dassios, Theodore;Kaltsogianni, Ourania;Greenough, Anne
背景资料：关于第二个疗程全身性产后皮质类固醇导致早产儿通气成功拔管及其对呼吸功能影响的有效性的数据很少。目的：为了确定第二个疗程的全身地塞米松成功拔管早产儿的疗效，并描述呼吸功能的变化，发生在第二个疗程的管理方法：回顾性队列研究的通气婴儿小于30周的妊娠谁收到了9天的第二个疗程的静脉地塞米松在第三新生儿病房。如果婴儿在尝试拔管后72小时内没有重新插管，则认为拔管成功。我们计算了通气/灌注比（V-A/Q）和所需氧（FIO 2）的百分比表示的需求之前和之后的过程。结果如下：在出生后60（48-73）天研究了15例（10例男性）婴儿，中位（IQR）胎龄（GA）为25.7（24.7-26.6）周，出生体重为0.79（0.67-0.93）kg。15名婴儿中有14名（93%）成功拔管。疗程前V-A/Q为0.13（0.11-0.16），疗程开始后72小时显著升高[0.26（0.19-0.36），p = 0.001]。FIO 2需求量在疗程开始后9天从0.70（0.59-0.79）降至0.34（0.28-0.52）（p < .001）。结论：第二个疗程的全身性地塞米松似乎有效地使早产儿脱离有创通气，并与氧合的显着改善有关。
Background: There is a paucity of data concerning the efficacy of a second course of systemic postnatal corticosteroids resulting in a successful extubation of prematurely-born, ventilated infants and its effect on their respiratory function. Objectives: To determine the efficacy of a second course of systemic dexamethasone in successful extubation of prematurely-born infants and to describe the respiratory function changes that occur following the administration of the second course Methods: Retrospective cohort study of ventilated infants less than 30 weeks of gestation who received a nine-day second course of intravenous dexamethasone in a tertiary neonatal unit. Extubation was deemed successful if the infants were not re-intubated within 72 h of the extubation attempt. We calculated the ventilation perfusion ratio (V-A/Q) and the fraction of required oxygen (FIO2) requirement expressed as a percentage before and after the course. Results: Fifteen (10 male) infants with a median (IQR) gestational age (GA) of 25.7 (24.7-26.6) weeks and a birth weight of 0.79 (0.67-0.93) kg were studied at a postnatal age of 60 (48-73) days. Fourteen of fifteen infants (93%) were successfully extubated. The V-A/Q before the course was 0.13 (0.11-0.16) and significantly higher at 72 h after starting the course [0.26 (0.19-0.36), p = 0.001]. The FIO2 requirement decreased from 0.70 (0.59-0.79) to 0.34 (0.28-0.52) nine days after starting the course (p < .001). Conclusions: A second course of systemic dexamethasone appears efficient in weaning premature infants off invasive ventilation and is associated with a significant improvement in oxygenation.