Department of Paediatrics, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia.
Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):336-341. doi: 10.1136/archdischild-2020-319804. Epub 2020 Sep 28.
Surfactant is an effective treatment for respiratory distress syndrome, being particularly important for infants in whom continuous positive airway pressure (CPAP) provides insufficient support. Supraglottic airway devices present an attractive option for surfactant delivery, particularly as an alternative to methods dependent on direct laryngoscopy, a procedural skill that is both difficult to learn and in which to maintain competence. Published studies provide encouraging data that surfactant administration by supraglottic airway device can be performed with a high rate of success and may reduce the need for subsequent intubation compared with either continued CPAP or surfactant administration via endotracheal tube. However, existing randomised controlled trials (RCTs) are heterogeneous in design and include just over 350 infants in total. To date, all RCT evidence has been generated in tertiary units, whereas the greatest potential for benefit from the use of these devices is likely to be in non-tertiary settings. Future research should investigate choice and utility of device in addition to safety and effectiveness of procedure. Importantly, studies conducted in non-tertiary settings should evaluate feasibility, meaningful clinical outcomes and the impact that this approach might have on infants and their families. Supraglottic airway devices may represent a simple and effective mode of surfactant administration that can be widely used by a variety of clinicians. However, further well-designed RCTs are required to determine their role, safety and effectiveness in both tertiary and non-tertiary settings before introduction into routine clinical practice.
表面活性物质是治疗呼吸窘迫综合征的有效方法，对于那些持续气道正压通气（CPAP）支持不足的婴儿尤为重要。声门上气道装置为表面活性物质的输送提供了一个有吸引力的选择，特别是作为一种替代直接喉镜的方法，因为这种方法既难以学习，又难以保持熟练程度。已发表的研究提供了令人鼓舞的数据，表明通过声门上气道装置给予表面活性物质可以获得很高的成功率，并且与持续 CPAP 或通过气管内管给予表面活性物质相比，可能减少随后需要插管的可能性。然而，现有的随机对照试验（RCT）在设计上存在异质性，总共包括 350 多名婴儿。迄今为止，所有 RCT 证据均来自三级单位，而这些设备的最大潜在获益可能来自于非三级单位。未来的研究应除了研究程序的安全性和有效性之外，还应调查设备的选择和实用性。重要的是，在非三级单位进行的研究应评估该方法的可行性、有意义的临床结果以及对婴儿及其家庭的影响。声门上气道装置可能代表了一种简单有效的表面活性物质给药方式，可以由各种临床医生广泛使用。然而，在引入常规临床实践之前，需要进一步设计良好的 RCT 来确定其在三级和非三级单位的作用、安全性和有效性。
