Paediatrics, University of Lübeck, Lübeck, Germany.
Arch Dis Child Fetal Neonatal Ed. 2019 Nov;104(6):F655-F659. doi: 10.1136/archdischild-2018-316557. Epub 2019 Jul 11.
Non-invasive ventilation and especially the application of continuous positive airway pressure (CPAP) has become standard for the treatment of premature infants with respiratory problems. However, CPAP failure may occur due to respiratory distress syndrome, that is, surfactant deficiency. Less invasive surfactant administration (LISA) aims to provide an adequate dose of surfactant while the infant is breathing spontaneously, thus avoiding positive pressure ventilation support. Using a thin catheter for surfactant application allows infants to maintain function of the glottis and continue spontaneous breathing, whereas the INtubate-SURfactant-Extubate (INSURE) procedure is connected with sedation/analgesia, regular intubation and a (brief) period of positive pressure ventilation. Individual studies and meta-analyses summarised in this review point in the direction that LISA is more effective than standard treatment or INSURE both in terms of short-term (avoidance of mechanical ventilation) and long-term (intracerebral haemorrhage and bronchopulmonary dysplasia) outcomes. Open questions include exact treatment thresholds for different gestational ages, the usefulness of devices/catheters that have recently been purpose-built for the LISA technique and especially the question of analgesia/sedation during the procedure. The current technology still demands laryngoscopy with all its unpleasant effects for infants. Therefore, studies with pharyngeal surfactant deposition immediately after delivery, the use of laryngeal airways for surfactant administration and attempts to nebulise surfactant are under way. Finally, LISA is not simply an isolated technical procedure for surfactant delivery but rather part of a comprehensive non-invasive approach supporting the concept of a gentle transition to the extrauterine world enabling preterm infants to benefit from the advantages of spontaneous breathing.
经鼻持续气道正压通气（NCPAP）和尤其持续气道正压通气（CPAP）已成为治疗有呼吸问题的早产儿的标准治疗方法。然而，由于呼吸窘迫综合征（即肺表面活性物质缺乏），CPAP 可能会失败。微创肺表面活性物质治疗（LISA）旨在在婴儿自主呼吸时提供足够剂量的肺表面活性物质，从而避免正压通气支持。使用细导管进行肺表面活性物质给药可以使婴儿保持声门功能并继续自主呼吸，而 INtubate-SURfactant-Extubate（INSURE）程序则需要镇静/镇痛、常规插管和短暂的正压通气。本综述中总结的个别研究和荟萃分析表明，LISA 在短期（避免机械通气）和长期（颅内出血和支气管肺发育不良）结局方面均优于标准治疗或 INSURE。仍存在一些悬而未决的问题，包括不同胎龄的具体治疗阈值、最近专门为 LISA 技术设计的设备/导管的实用性以及该过程中镇痛/镇静的问题。目前的技术仍然需要进行喉镜检查，这对婴儿有不良影响。因此，正在进行一些研究，包括分娩后立即进行咽表面活性物质沉积、使用喉气道进行表面活性物质给药以及尝试雾化肺表面活性物质。最后，LISA 不仅仅是一种用于肺表面活性物质给药的孤立技术程序，而是一种非侵入性综合方法的一部分，该方法支持向宫外世界的温和过渡的概念，使早产儿能够受益于自主呼吸的优势。
