Tribolet Sophie, Hennuy Nadège, Snyers Diane, Lefèbvre Caroline, Rigo Vincent
Neonatology Division, University Hospital of Liège, Liège, Belgium.
Neonatology. 2022;119(2):137-150. doi: 10.1159/000521553. Epub 2022 Feb 4.
Surfactant therapy is the cornerstone of respiratory distress syndrome management. "Less-invasive surfactant administration (LISA)" is now recommended for spontaneously breathing preterm infants. Analgosedation remains controversial as 52% of European neonatologists do not use any. This systematic review aims to describe the efficacy and safety of different drugs for analgosedation during LISA.
MEDLINE via Ovid, Embase, Scopus, and Cochrane Library of Trials were searched independently by 2 reviewers for studies on sedation or analgesia for LISA, without filters or limits.
Eight studies (1 randomized controlled trial) recruiting 945 infants were included. Infant pain was significantly reduced, with more infants evaluated as comfortable. Failure, defined as need for intubation or for a second dose of surfactant, was not different between sedated and unsedated groups. Analgosedation was associated with a higher occurrence of desaturation and need for positive pressure ventilation during procedure, but the need for mechanical ventilation within 24 or 72 h of life was not significantly different. There does not seem to be any difference in clinical tolerance and complications (e.g., hypotension, mortality, air leaks, etc.). Procedural conditions were evaluated as good or excellent in 83% after sedation.
Analgesia or sedative drugs increase infant comfort and allow good procedural conditions, with a limited impact on the clinical evolution. Questions remain about the best choice of drugs and dosages, with the constraint to maintain spontaneous breathing and have a rapid offset. Further good quality studies are needed to provide additional evidence to supplement those limited existing data.
表面活性剂疗法是呼吸窘迫综合征治疗的基石。目前推荐对自主呼吸的早产儿采用“微创表面活性剂给药（LISA）”。镇痛镇静仍存在争议，因为52%的欧洲新生儿科医生不使用任何镇痛镇静措施。本系统评价旨在描述LISA期间不同镇痛镇静药物的疗效和安全性。
两名研究者独立检索通过Ovid平台的MEDLINE、Embase、Scopus以及Cochrane试验库，以查找关于LISA镇静或镇痛的研究，不设筛选条件或限制。
纳入了8项研究（1项随机对照试验），共945例婴儿。婴儿疼痛明显减轻，更多婴儿被评估为舒适。定义为需要插管或使用第二剂表面活性剂的失败情况，在镇静组和未镇静组之间无差异。镇痛镇静与操作过程中更高的血氧饱和度下降发生率和正压通气需求相关，但出生后24小时或72小时内机械通气的需求无显著差异。临床耐受性和并发症（如低血压、死亡率、气胸等）似乎没有差异。镇静后83%的操作条件被评估为良好或优秀。
镇痛或镇静药物可提高婴儿舒适度并使操作条件良好，对临床病程影响有限。关于药物和剂量的最佳选择仍存在疑问，同时存在维持自主呼吸和快速起效时间的限制。需要进一步的高质量研究来提供更多证据，以补充那些有限的现有数据。
