ABSTRACT
Objective:To evaluate the efficacy and safety of less invasive surfactant administration (LISA) combined with nasal intermittent positive pressure ventilation (NIPPV) in the treatment of infants with respiratory distress syndrome (RDS).Methods:A prospective study was conducted on preterm infants of gestational age ≤34 weeks with RDS who were admitted to the Neonatal Intensive Care Unit of Xuzhou Central Hospital from October 2019 to November 2021. The infants were randomly assigned into the LISA+NIPPV group and the intubation-surfactant-extubation (INSURE) +nasal continuous positive airway pressure (NCPAP) group. In the LISA+NIPPV group, with the support of NIPPV, a Lisa tube was inserted through the vocal cords under direct vision with direct laryngoscope, and then pulmonary surfactant (PS) was infused into the lung. In the INSURE+NCPAP group, the patients were endotracheally intubated and infused with PS into the lung through endotracheal tube, then extubated and continued to receive NCPAP therapy (INSURE). The blood gas analysis at 1 h and 6 h after PS infusion, the adverse reactions during injection, clinical efficacy, bronchopulmonary dysplasia (BPD) and other related complications were compared between the two groups.Results:A total of 112 preterm infants with RDS were enrolled, including 58 in the LISA+NIPPV group and 54 in the INSURE+NCPAP group. The blood oxygen partial pressure (PaO 2) and PaO 2/FiO 2 (P/F) in the LISA+NIPPV group were significantly higher than those in the INSURE+NCPAP group at 1 h and 6 h after PS infusion, while carbon dioxide partial pressure (PaCO 2) were significantly lower than that in the INSURE+NCPAP group, and the differences were statistically significant (all P<0.05). The rate of tracheal intubation within 72 h (15.5% vs. 33.3%), the duration of non-invasive ventilation [ (7.5 ± 4.3) d vs.(9.9 ± 5.5) d ], total oxygen inhaling [ (10.5 ± 3.5) d vs.(13.3 ± 4.1) d ], failure rate of machine withdrawal (8.6% vs. 31.0% ), the times of apnea [7.0 (3.0-21.0) times vs. 15.0 (4.0-28.0) times ] and re-administration of PS (17.2% vs. 33.3%) in the LISA+NIPPV group were significantly lower than those in the INSURE+NCPAP group, and the differences were statistically significant ( P<0.05). The incidence of regurgitation in the LISA+NIPPV group was lower than that in the INSURE+NCPAP group (13.8% vs. 35.2%), and the difference was statistically significant ( P<0.05). There was no significant difference in the time needed for intubation between the two groups ( P>0.05). The occurrence of BPD in the LISA+NIPPV group was significantly lower than that in the INSURE+NCPAP group (10.3% vs. 25.9%), and there was no significant difference in other related complication between the two groups (all P>0.05). Conclusions:LISA combined with NIPPV in the treatment of preterm infants with RDS can effectively improve oxygenation, reduce carbon dioxide retention, reduce the mechanical ventilation rate, shorten the duration of noninvasive mechanical ventilation, and reduce the incidence of BPD.
ABSTRACT
Objective:To study the efficacy and safety of less invasive surfactant administration (LISA) combined with bi-level positive airway pressure (BiPAP) ventilation in premature infants with respiratory distress syndrome (RDS).Methods:Premature infants with RDS at gestational age of 26~32 weeks in the NICU of our hospital from January 2020 to October 2021 were enrolled in this randomized controlled trial. They were randomly assigned to the LISA+BiPAP group or the intubation-surfactant-extubation (INSURE) + nasal continuous positive airway pressure (NCPAP) group, and given the corresponding treatment according to the group. The blood gas analysis at 1 h and 6 h after intratracheal instillation of pulmonary surfactant (PS), medication, noninvasive respiratory support time, total oxygen use time, weaning failure rate and endotracheal intubation rate within 72 h after PS administration were compared between the two groups, as well as the incidence of bronchopulmonary dysplasia (BPD).Results:A total of 86 preterm infants with RDS were enrolled in the study, including 44 in the LISA+BiPAP group and 42 in the INSURE+NCPAP group. Arterial partial pressure of oxygen in the LISA+BiPAP group at 1 h and 6 h after intratracheal instillation of PS were higher than those in the INSURE+NCPAP group, while PaCO 2 and oxygenation index (OI) were lower than those in the INSURE+NCPAP group, and the differences were statistically significant (all P<0.05). The duration of noninvasive respiratory support time [(12.2±8.7) d vs. (16.0 ±7.6) d], total oxygen use time [(16.6 ±8.3) d vs. (20.3±7.4) d], length of hospitalization[(22.6±10.3) d vs. (27.1±12.6) d], weaning failure rate [(11.4% (5/44) vs. 31.0% (13/42)], endotracheal intubation rate within 72 h after PS administration [11.4% (5/44) vs. 28.6% (12/42)], and re-administration of PS [18.2% (8/44) vs. 38.1% (16/42)] in the LISA+BiPAP group were lower than those in the INSURE+NCPAP group, and the differences were statistically significant ( P<0.05). The time needed for intubation and the incidence of regurgitation in the LISA+BiPAP group were lower than those in the INSURE+NCPAP group, and the differences were statistically significant ( P<0.05). The incidence of BPD in the LISA+BiPAP group was lower than those in the INSURE+NCPAP group [11.4% (5/44) vs. 31.0% (13/42)] ( P<0.05), the difference was also statistically significant ( P<0.05). There was no significant difference in the incidence of other complications between the two groups ( P>0.05). Conclusions:LISA combined with BiPAP can effectively improve oxygenation, reduce the mechanical ventilation rate, shorten the duration of non-invasive respiratory support, and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26~32 weeks.
ABSTRACT
Objective:To evaluate the efficacy and safety of less invasive surfactant administration (LISA) combined with caffeine citrate in the treatment of respiratory distress syndrome (RDS) in preterm infants receiving continuous positive airway pressure (NCPAP) ventilation.Methods:From August 2019 to April 2021, a total of 112 preterm infants with RDS (26 weeks≤gestational age ≤32 weeks) who were hospitalized in the Neonatal Intensive Care Unit of Xuzhou Central Hospital, were chosen as research subjects. The patients were randomly divided into the LISA combined treatment group ( n=58) and the INSURE group ( n=54). In the LISA combined treatment group, a LISA tube was inserted through the vocal cords under direct vision with a direct laryngoscope and then infused with pulmonary surfactant (PS) into the lung when NCPAP ventilation was applied, and caffeine citrate was given intravenously. In the INSURE group, the patients were endotracheally intubated and infused with PS into the lung through an endotracheal tube, and then extubated and put on NCPAP again. The following indicators were examined: the general clinical data, results of blood gas analysis at 1 h and 6 h after infusion of PS into the lung, clinical efficacy and related complications. Results:①No significant differences were found between the two groups in the general clinical data (all P>0.05).Intra-group comparison within LISA combined treatment group or INSURE group showed that partial pressure of arterial carbon dioxide (PaCO 2), partial pressure of arterial oxygen (PaO 2) of blood gas analysis and PaO 2/fraction of inspired oxygen (P/F) at 1 h and 6 h after infused PS into the lung were all improved compared to those of before treatment, and the differences were statistically significant (all P<0.05). The PaO 2 and P/F in the LISA combined treatment group at 1 h and 6 h after breath support therapy were higher than those in the INSURE group, while PaCO 2 was lower than that in the INSURE group, and the differences were statistically significant (all P<0.05). The duration of noninvasive ventilation, total oxygen inhalation, re-administration of PS, failure rate of machine withdrawal, the rate of tracheal intubation within 72 h and the times of apnea in the LISA combined treatment group were significantly shorter, or lower, or less than those in the INSURE group [3.0 (1.0, 18.0) d vs. 7.5 (2.0, 22.0) d, 5.5 (3.0, 21.0) d vs. 10.5 (4.0, 28.0) d, 9 (15.5%) vs. 17 (31.5%), 6 (10.3%) vs. 14 (25.9%), 5 (8.6%) vs. 12 (22.2%), 5.0 (3.0, 21.0) times vs. 15.0 (4.0, 28.0) times], and the differences were all statistically significant (all P<0.05). The incidence of bronchopulmonary dysplasia in the LISA combined treatment group was less than that in the INSURE group [(5 (8.6%) vs. 13 (24.1%)], and the difference was statistically significant ( P<0.05). There was no significant difference between the two groups in other complications( P>0.05). Conclusions:Compared with INSURE, the LISA technique combined with caffeine citrate can effectively improve oxygenation, reduce the mechanical ventilation rate, shorten the duration of noninvasive mechanical ventilation, and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26-32 weeks.
ABSTRACT
Objective To assess the clinical efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) for prevention of extubation failure in preterm infants with respiratory distress syndrome (RDS).Methods From March 2016 to December 2017,75 preterm infants (≤32 weeks gestation) with RDS who needed noninvasive respiratory support after a period of mechanical ventilation with an endotracheal tube in neonatal intensive care unit were studied.They were randomly assigned into the HHHFNC group (38 cases) and the NCPAP group (37 cases) by using a random number table.The main observation was the success rate of removal of the ventilator,duration of noninvasive ventilation time,the total oxygen inhaling time,feeding conditions and incidence of adverse events.Results The baseline demographic characteristics of the two groups were similar in terms of gestational age,birth weight,gender,incidence of cesarean delivery,premature rupture of membranes,administrations of antenatal glucocorticoid prophylaxis,Apgar scores at 1 and 5 minutes (P ＞ 0.05).No significant difference was found in the success rate of removal of the ventilator between HHHFNC group and NCPAP group(94.7 ％ vs.91.9％,P ＞ 0.05).The time of noninvasive ventilation,the total oxygen inhaling time and hospital stay in the NCPAP group were shorter than those in the HHHFNC group,but there were no significant differences between two groups (P ＞ 0.05).The occurrence of abdominal distention (10.5％ vs.27.05％),nasal trauma(5.2％ vs.21.6％),head shaping(0 vs.32.4％) were lower in HHHFNC group than those in NCPAP group (P ＜0.05).The time needed to achieve total enteral nutrition[(10.1 ± 1.2) d vs.(14.1 ± 1.6)d] and the incidence of feeding intolerance (13.1％ vs.29.7％) were reduced in HHHFNC group than those in NCPAP group (P ＜ 0.05).Conclusion As an respiratory support for the treatment of preterm infants with RDS after extubation,HHHFNC has the similar efficacy with NCPAP.However,HHHFNC has lower incidence of nasal trauma,abdominal distension and feeding intolerance,and further clinical research is needed.