Verlato Giovanna, Cogo Paola Elisa, Balzani Marco, Gucciardi Antonina, Burattini Ilaria, De Benedictis Fernando, Martiri Giovanna, Carnielli Virgilio Paolo
Department of Pediatrics, University of Padova, Padova, Italy.
Pediatrics. 2008 Jul;122(1):102-8. doi: 10.1542/peds.2007-1021.
The goal was to establish whether reduced amounts of pulmonary surfactant contribute to postextubation respiratory failure in preterm infants recovering from respiratory distress syndrome.
We prospectively recruited preterm infants who needed mechanical ventilation and exogenous surfactant for treatment of moderate/severe respiratory distress syndrome and could not be extubated before day 3 of life. (13)C-labeled dipalmitoyl-phosphatidylcholine was administered endotracheally as tracer before extubation, for estimation of surfactant disaturated phosphatidylcholine pool size and half-life. Patients were retrospectively divided into 3 groups, that is, extubation failure if, after extubation, they needed reintubation or continuous positive airway pressure treatment of >or=6 cmH(2)O and fraction of inspired oxygen of >0.4, extubation success if they did not meet the failure criteria, and not extubated if they needed ongoing ventilation. Clinical and respiratory parameters were recorded hourly.
Reliable kinetic data could be obtained for 63 of the 88 enrolled neonates. Sixteen, 23, and 24 neonates were categorized in the extubation failure, extubation success, and not extubated groups, respectively. Clinical and demographic characteristics did not differ between the extubation failure and extubation success groups. Disaturated phosphatidylcholine pool size was smaller in the extubation failure group than in the extubation success group (25 +/- 12 vs 43 +/- 24 mg/kg) and was 37 +/- 32 mg/kg in the not extubated group. Disaturated phosphatidylcholine half-life was 19 +/- 7, 24 +/- 12, and 28 +/- 18 hours in the extubation failure, extubation success, and not extubated groups, respectively.
In a selected population of preterm infants with moderate/severe respiratory distress syndrome who could not be extubated in the first 3 days of life, infants who were reintubated or needed high continuous positive airway pressure settings after extubation had a smaller disaturated phosphatidylcholine pool size than did those who were successfully extubated or needed low continuous positive airway pressure settings.
旨在确定肺表面活性物质含量减少是否会导致呼吸窘迫综合征恢复期的早产儿拔管后呼吸衰竭。
我们前瞻性招募了需要机械通气和外源性表面活性物质治疗中度/重度呼吸窘迫综合征且在出生后第3天前无法拔管的早产儿。在拔管前经气管内给予(13)C标记的二棕榈酰磷脂酰胆碱作为示踪剂，以估计表面活性物质双饱和磷脂酰胆碱池大小和半衰期。患者被回顾性分为3组，即拔管失败组（拔管后需要重新插管或持续气道正压治疗≥6 cmH₂O且吸入氧分数>0.4）、拔管成功组（不符合失败标准）和未拔管组（需要持续通气）。每小时记录临床和呼吸参数。
88例纳入的新生儿中，63例可获得可靠的动力学数据。拔管失败组、拔管成功组和未拔管组分别有16例、23例和24例新生儿。拔管失败组和拔管成功组的临床和人口统计学特征无差异。拔管失败组的双饱和磷脂酰胆碱池大小小于拔管成功组（25±12 vs 43±24 mg/kg），未拔管组为37±32 mg/kg。拔管失败组、拔管成功组和未拔管组的双饱和磷脂酰胆碱半衰期分别为19±7、24±12和28±18小时。
在出生后前3天无法拔管的中度/重度呼吸窘迫综合征早产儿特定人群中，拔管后需要重新插管或高持续气道正压设置的婴儿，其双饱和磷脂酰胆碱池大小小于成功拔管或需要低持续气道正压设置的婴儿。
