早产儿无创呼吸支持与有创呼吸支持的比较

IF 3.2 3区 医学 Q1 OBSTETRICS & GYNECOLOGY Seminars in perinatology Pub Date : 2024-03-01 DOI:10.1016/j.semperi.2024.151885
Brett J. Manley , Emily Cripps , Peter A. Dargaville
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引用次数: 0

摘要

早产儿呼吸功能不全几乎无处不在,其发生率随着胎龄的降低而增加。针对这些早产儿有多种呼吸支持管理策略,可分为非侵入性和侵入性呼吸支持形式。在此,我们回顾了早产儿呼吸护理的历史和演变,然后研究了支持无创呼吸管理方法的证据。持续气道正压(CPAP)是目前获益证据最多的无创呼吸支持模式。CPAP 可以安全有效地进行,并可在产房开始使用。特别是在生命早期,使用无创呼吸支持,避免插管和机械通气,可减少肺损伤,从而降低支气管肺发育不良的发病率,对早产儿有益。近年来,外源性表面活性物质给药的新技术进一步推动了无创支持技术的应用。创伤性较小的表面活性物质给药方法,尤其是使用细导管的方法,使新生儿科医生能够在不进行气管插管的情况下使用表面活性物质。这种方法的益处似乎是持续性的,甚至对那些随后需要机械通气的婴儿也是如此。这进一步证实了一个观点,即减少机械通气可减轻早产儿脆弱肺部的损伤,而且效果持久。尽管无创呼吸支持具有明显的优势,但插管和机械通气对某些早产儿仍有作用,尤其是对妊娠 25 周的早产儿。目前还不清楚早期无创支持在这一特殊人群中的作用,需要进行更多的研究。
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Non-invasive versus invasive respiratory support in preterm infants

Respiratory insufficiency is almost ubiquitous in infants born preterm, with its incidence increasing with lower gestational age. A wide range of respiratory support management strategies are available for these infants, separable into non-invasive and invasive forms of respiratory support. Here we review the history and evolution of respiratory care for the preterm infant and then examine evidence that has emerged to support a non-invasive approach to respiratory management where able. Continuous positive airway pressure (CPAP) is the non-invasive respiratory support mode currently with the most evidence for benefit. CPAP can be delivered safely and effectively and can commence in the delivery room. Particularly in early life, time spent on non-invasive respiratory support, avoiding intubation and mechanical ventilation, affords benefit for the preterm infant by virtue of a lessening of lung injury and hence a reduction in incidence of bronchopulmonary dysplasia. In recent years, enthusiasm for application of non-invasive support has been further bolstered by new techniques for administration of exogenous surfactant. Methods of less invasive surfactant delivery, in particular with a thin catheter, have allowed neonatologists to administer surfactant without resort to endotracheal intubation. The benefits of this approach appear to be sustained, even in those infants subsequently requiring mechanical ventilation. This cements the notion that any reduction in exposure to mechanical ventilation leads to alleviation of injury to the vulnerable preterm lung, with a long-lasting effect. Despite the clear advantages of non-invasive respiratory support, there will continue to be a role for intubation and mechanical ventilation in some preterm infants, particularly for those born <25 weeks’ gestation. It is currently unclear what role early non-invasive support has in this special population, with more studies required.

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来源期刊
Seminars in perinatology
Seminars in perinatology 医学-妇产科学
CiteScore
5.80
自引率
2.90%
发文量
97
审稿时长
6-12 weeks
期刊介绍: The purpose of each issue of Seminars in Perinatology is to provide authoritative and comprehensive reviews of a single topic of interest to professionals who care for the mother, the fetus, and the newborn. The journal''s readership includes perinatologists, obstetricians, pediatricians, epidemiologists, students in these fields, and others. Each issue offers a comprehensive review of an individual topic, with emphasis on new developments that will have a direct impact on their practice.
期刊最新文献
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