Department of Paediatrics, Royal Hobart Hospital, Liverpool Street, Hobart TAS 7000, Australia.
Arch Dis Child Fetal Neonatal Ed. 2013 Mar;98(2):F122-6. doi: 10.1136/archdischild-2011-301314. Epub 2012 Jun 9.
To evaluate the applicability and potential effectiveness of a technique of minimally-invasive surfactant therapy (MIST) in preterm infants on continuous positive airway pressure (CPAP).
An open feasibility study of MIST was conducted at two sites. Infants were eligible for MIST if needing CPAP pressure ≥7 cm H(2)O and FiO(2) ≥0.3 (25-28 weeks gestation, n=38) or ≥0.35 (29-32 weeks, n=23). Without premedication, a narrow-bore catheter was inserted through the vocal cords under direct vision. Surfactant (100 or 200 mg/kg Curosurf) was then instilled, followed by reinstitution of CPAP. Outcomes were compared between surfactant-treated infants and historical controls achieving the same CPAP and FiO(2) thresholds.
Surfactant was successfully administered via MIST in all cases, with a rapid and sustained reduction in FiO(2) thereafter. For infants at 25-28 weeks gestation, need for intubation <72 h was diminished after MIST compared with controls (32% vs 68%; OR 0.21, 95% CI 0.083 to 0.55), with a similar trend at 29-32 weeks (22% vs 45%; OR 0.34, 95% CI 0.11 to 1.1). Duration of ventilation and incidence of bronchopulmonary dysplasia were similar, but infants receiving MIST had a shorter duration of oxygen therapy.
Surfactant delivery via a narrow-bore tracheal catheter is feasible and potentially effective, and deserves further investigation in clinical trials.
评估经鼻持续气道正压通气（CPAP）治疗早产儿时微创表面活性剂治疗（MIST）技术的适用性和潜在效果。
在两个地点进行了一项 MIST 的开放性可行性研究。如果需要 CPAP 压力≥7cmH₂O 和 FiO₂≥0.3（25-28 周妊娠）或≥0.35（29-32 周妊娠），则符合 MIST 条件的婴儿有资格接受 MIST。在没有预先用药的情况下，通过喉镜直视下将一根窄口径导管插入声带。然后注入表面活性剂（100 或 200mg/kg Curosurf），然后重新开始 CPAP。将接受表面活性剂治疗的婴儿与达到相同 CPAP 和 FiO₂阈值的历史对照婴儿的结果进行比较。
所有情况下均成功通过 MIST 给予表面活性剂，此后 FiO₂迅速且持续降低。对于 25-28 周妊娠的婴儿，与对照组相比，MIST 后需要在 72 小时内插管的比例降低（32%比 68%；OR 0.21，95%CI 0.083-0.55），在 29-32 周妊娠时也有类似趋势（22%比 45%；OR 0.34，95%CI 0.11-1.1）。通气时间和支气管肺发育不良的发生率相似，但接受 MIST 的婴儿吸氧时间更短。
通过窄口径气管导管输送表面活性剂是可行的，并且可能有效，值得在临床试验中进一步研究。
