Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RS, United Kingdom.
Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom.
Early Hum Dev. 2021 Mar;154:105311. doi: 10.1016/j.earlhumdev.2021.105311. Epub 2021 Jan 22.
On the neonatal unit less invasive surfactant administration (LISA) reduces BPD and the need for mechanical ventilation.
To evaluate the feasibility of LISA in the delivery suite and to undertake respiratory function physiological monitoring before and after LISA.
A prospective, observational cohort study was undertaken. A LISA simulation training programme was delivered. Then, LISA was undertaken in infants with respiratory distress maintained on continuous positive airway pressure (CPAP) in the delivery suite using videolaryngoscopic guidance without sedation.
Thirty-eight infants with a median (IQR) gestational age of 31 + weeks (30-33) and birth weight of 1.61 (1.42-1.90) kg had LISA in the delivery suite.
Adverse effects of LISA and whether LISA resulted in changes in tidal and minute volumes, end tidal carbon dioxide (EtCO) levels and the inspired oxygen concentration (FiO).
Respiratory function monitoring was available for 34 of the infants. LISA occurred at a median (IQR) interval of 18 (15-29) minutes after birth. The most common adverse events were desaturation (44.7%) and surfactant reflux (39.5%), both responded to either temporary suspension of LISA or slowing the speed of surfactant administration. Following LISA, there was a significant reduction in respiratory rate 2 min later (p < 0.001) and in the FiO 2 h later (p < 0.001).
LISA is feasible in the delivery suite after appropriate training of staff. It can be undertaken without serious adverse effects and results in a reduction in respiratory distress and improvement in oxygenation.
在新生儿病房，微创表面活性剂给药（LISA）可减少 BPD 和机械通气的需求。
评估 LISA 在分娩室中的可行性，并在 LISA 前后进行呼吸功能生理监测。
进行了一项前瞻性观察队列研究。提供了 LISA 模拟培训计划。然后，在分娩室中使用视频喉镜引导，在持续气道正压通气（CPAP）下维持呼吸窘迫的婴儿中进行 LISA，无需镇静。
38 名婴儿的中位（IQR）胎龄为 31 周（30-33），出生体重为 1.61（1.42-1.90）kg，在分娩室中进行了 LISA。
LISA 的不良反应以及 LISA 是否导致潮气量和分钟通气量、呼气末二氧化碳（EtCO）水平和吸入氧浓度（FiO）的变化。
34 名婴儿的呼吸功能监测可用。LISA 发生在出生后中位数（IQR）间隔 18（15-29）分钟。最常见的不良事件是低氧血症（44.7%）和表面活性剂反流（39.5%），两者均通过暂时暂停 LISA 或减慢表面活性剂给药速度得到解决。LISA 后，2 分钟后呼吸频率明显下降（p < 0.001），2 小时后 FiO2 下降（p < 0.001）。
在经过适当的员工培训后，LISA 在分娩室中是可行的。它可以在没有严重不良事件的情况下进行，可减轻呼吸窘迫并改善氧合。
