Respiratory Care Department, Children's Medical Center, Dallas, TX 75235, USA.
Respir Care. 2013 Feb;58(2):367-75. doi: 10.4187/respcare.02189.
We searched the MEDLINE, CINAHL, and Cochrane Library databases for English-language randomized controlled trials, systematic reviews, and articles investigating surfactant replacement therapy published between January 1990 and July 2012. By inspection of titles, references having no relevance to the clinical practice guideline were eliminated. The update of this clinical practice guideline is based on 253 clinical trials and systematic reviews, and 12 articles investigating surfactant replacement therapy. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation scoring system: 1: Administration of surfactant replacement therapy is strongly recommended in a clinical setting where properly trained personnel and equipment for intubation and resuscitation are readily available. 2: Prophylactic surfactant administration is recommended for neonatal respiratory distress syndrome (RDS) in which surfactant deficiency is suspected. 3: Rescue or therapeutic administration of surfactant after the initiation of mechanical ventilation in infants with clinically confirmed RDS is strongly recommended. 4: A multiple surfactant dose strategy is recommended over a single dose strategy. 5: Natural exogenous surfactant preparations are recommended over laboratory derived synthetic suspensions at this time. 6: We suggest that aerosolized delivery of surfactant not be utilized at this time.
我们检索了 MEDLINE、CINAHL 和 Cochrane Library 数据库，以获取 1990 年 1 月至 2012 年 7 月期间发表的英文随机对照试验、系统评价和有关表面活性剂替代治疗的文章。通过标题检查，排除了与临床实践指南无相关性的参考文献。本临床实践指南的更新基于 253 项临床试验和系统评价，以及 12 项有关表面活性剂替代治疗的文章。以下建议是根据推荐评估、制定和评估评分系统制定的：1：在有经过适当培训的人员和插管及复苏设备的临床环境中，强烈建议使用表面活性剂替代治疗。2：建议对疑似表面活性剂缺乏的新生儿呼吸窘迫综合征（RDS）进行预防性表面活性剂治疗。3：在临床确诊的 RDS 婴儿开始机械通气后，强烈建议进行补救或治疗性表面活性剂治疗。4：建议使用多次表面活性剂剂量策略，而不是单次剂量策略。5：目前推荐使用天然外源性表面活性剂制剂，而不是实验室衍生的合成混悬剂。6：目前建议不要使用表面活性剂雾化给药。
