Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Curr Opin Pediatr. 2020 Apr;32(2):228-234. doi: 10.1097/MOP.0000000000000878.
The purpose of this review is to describe current concepts in the field of Less Invasive Surfactant Administration (LISA). The use of continuous positive airway pressure (CPAP) has become standard for the treatment of premature infants with respiratory problems throughout the world. However, if CPAP fails, technologies like LISA are needed that can combine surfactant delivery and spontaneous breathing with the support of noninvasive modes of ventilation.
LISA with thin catheters has been in use in Germany for more than 15 years. In the last 5 years, there was substantial interest in this method around the world. Randomized studies and recent metaanalyses indicate that the LISA technique helps to avoid mechanical ventilation especially in emerging respiratory distress syndrome (RDS). LISA is also associated with improved outcomes of preterm infants, specifically in the prevention of bronchopulmonary dysplasia (BPD) and intracranial hemorrhage (ICH). By now, a variety of different LISA catheters, devices and techniques have been described. However, most of the technologies are still connected with the unpleasant experience of laryngoscopy for the affected infants, so that the search for even less invasive techniques, for example, surfactant application by nebulization, goes on.
Maintenance of spontaneous breathing with support by the LISA technique holds big promise in the care of preterm infants. Patient comfort and lower complication rates are strong arguments to further investigate and promote the LISA approach. Open questions include exact indications for different patient groups, the usefulness of devices/catheters that have recently been built for the LISA technique and -- perhaps most urgently -- the issue of analgesia/sedation during the procedure. Studies on long-term outcome after LISA are under way.
本文旨在描述经鼻间歇正压通气（NIPPV）在早产儿肺表面活性物质治疗中的应用进展。目前，全球范围内对有呼吸系统问题的早产儿多采用持续气道正压通气（CPAP）治疗。然而，如果 CPAP 治疗失败，就需要应用 LISA 等技术，使肺表面活性物质的输送与自主呼吸相结合，并辅以无创通气模式的支持。
在德国，细导管 LISA 技术已应用了 15 年以上。在过去的 5 年中，该方法在世界范围内引起了广泛关注。随机对照研究和最近的荟萃分析表明，LISA 技术有助于避免机械通气，特别是在新生儿呼吸窘迫综合征（RDS）的早期。LISA 技术还与早产儿结局的改善有关，特别是在预防支气管肺发育不良（BPD）和颅内出血（ICH）方面。目前，已经描述了多种不同的 LISA 导管、设备和技术。然而，大多数技术仍然与患儿接受喉镜检查的不愉快经历有关，因此，人们仍在寻找更微创的技术，例如通过雾化进行肺表面活性物质的应用。
在早产儿的治疗中，LISA 技术在维持自主呼吸的同时提供支持，具有广阔的应用前景。患者舒适度和较低的并发症发生率是进一步研究和推广 LISA 方法的有力论据。目前仍存在一些悬而未决的问题，包括不同患者群体的确切适应证、最近为 LISA 技术设计的设备/导管的实用性，以及（也许是最紧迫的）操作过程中的镇痛/镇静问题。LISA 后长期结局的研究正在进行中。
