Leone F, Trevisanuto D, Cavallin F, Parotto M, Zanardo V
Department of Pediatrics, Padua University, Padua, Italy.
Minerva Pediatr. 2013 Apr;65(2):187-92.
INSURE (INtubation, SURfactant, Extubation) is a proven complement of nasal CPAP (nCPAP) for respiratory distress syndrome (RDS) treatment of preterm infants. Early administration is characterized by greater success. We aimed to determine the efficacy and failure or other respiratory outcomes of INSURE administration during nasal continous positive airway pressure (nCPAP) treatment of RDS.
Among 824 premature infants neonatal intensive care unit (NICU) admitted at Padua University Hospital during 2007-2009, 209 (25.4%) were managed by surfactant replacement (200 mg/kg, Curosurf®) if required >45% oxygen ("rescue" treatment), including 42 (20.1%) during nCPAP. Each premature infant treated with INSURE during nasal CPAP was compared to 2 consecutive control infants treated with surfactant during mechanical ventilation, matched for antenatal steroids, delivery route, gestational age, and sex.
Infants with RDS, treated with nCPAP and INSURE-complement (N.=25), were comparable in Apgar score, need of PPV at birth, birth weight, pre-surfactant FiO2 and timing of surfactant replacement to controls. However, nCPAP and INSURE-complement was superior in terms both of oxygenation, evaluated as post-treatment FiO2 (Median, [IQR], 26 [21-40] vs. 21 [21-29]; P=0.03) and (a-A) pO2 (0.48 [0.45-0.60] vs. 0.58 [0.53-0.72]; P=0.03). The improved oxygenation was sustained over the following days. In addition, premature infants treated with nCPAP and INSURE-complement developed less respiratory co-morbidities, including pneumothorax, borncopulmonary disease (BPD), and BPD and death (P=0.04).
INSURE-complement of nasal CPAP has a superior efficacy in terms of oxygenation improvement, maintenance of optimal oxygenation, and reduction of respiratory comorbidities respect to "rescue" surfactant administration during mechanical ventilation.
INSURE（插管、表面活性剂、拔管）是已被证实的用于治疗早产儿呼吸窘迫综合征（RDS）的鼻持续气道正压通气（nCPAP）的补充治疗方法。早期应用成功率更高。我们旨在确定在nCPAP治疗RDS期间应用INSURE的疗效、失败情况或其他呼吸结局。
在2007年至2009年期间入住帕多瓦大学医院新生儿重症监护病房（NICU）的824例早产儿中，209例（25.4%）在需要>45%氧气时接受了表面活性剂替代治疗（200mg/kg，珂立苏®）（“挽救”治疗），其中42例（20.1%）在nCPAP治疗期间接受了该治疗。将在鼻CPAP期间接受INSURE治疗的每例早产儿与2例在机械通气期间接受表面活性剂治疗的连续对照婴儿进行比较，对照婴儿在产前使用类固醇、分娩途径、胎龄和性别方面相匹配。
接受nCPAP和INSURE补充治疗的RDS婴儿（N=25）在阿氏评分、出生时需要正压通气、出生体重、使用表面活性剂前的吸入氧分数（FiO2）以及表面活性剂替代时间方面与对照组相当。然而，nCPAP和INSURE补充治疗在氧合方面更具优势，以治疗后的FiO2评估（中位数，[四分位间距]，26[21-40]对21[21-29]；P=0.03）以及（肺泡-动脉）氧分压差（a-A）pO2（0.48[0.45-0.60]对0.58[0.53-0.72]；P=0.03）。改善的氧合在接下来的几天中持续存在。此外，接受nCPAP和INSURE补充治疗的早产儿发生的呼吸合并症较少，包括气胸、支气管肺发育不良（BPD）以及BPD和死亡（P=0.04）。
与在机械通气期间进行“挽救”性表面活性剂给药相比，鼻CPAP的INSURE补充治疗在改善氧合、维持最佳氧合以及减少呼吸合并症方面具有更高的疗效。
