Brahmbhatt Shaily, Read Brooke, Da Silva Orlando, Bhattacharya Soume
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
London Health Sciences Centre, London, Ontario, Canada.
Can J Respir Ther. 2022 Jul 28;58:122-126. doi: 10.29390/cjrt-2022-011. eCollection 2022.
Minimally invasive surfactant therapy (MIST) can be used to treat neonatal respiratory distress syndrome in neonatal intensive care units (NICUs). Clinical and institutional variances in MIST utilization persist globally with little published research regarding MIST utilization in Canada. Therefore, the objective of this study was to survey MIST utilization in NICUs in Canada.
An online survey was emailed to the 33 participating centres of Canadian Neonatal Network (CNN) Evidence-based Practice for Improving Quality (EPIQ) Lung Health Group (LHG). Site demographics and surfactant therapy procedural details were categorically collected. Free text and multiple-choice questions were utilized to capture perceived barriers and individual preferences for MIST use.
Twenty-eight of 33 participating members of the CNN EPIQ-LHG completed the survey between April 2021 and October 2021 (85%); 17/28 (61%) respondents reported ongoing MIST utilization at their center. Most centers that used MIST techniques administered bovine lipid extract surfactant (68%), commonly using angiocatheters (47%) and purpose-built catheters (41%). MIST was widely used for patients at 26-33 weeks gestational age (88%). Nine centres had never used MIST (32%), and 3 indicated a plan to implement MIST within the next 2 years. Common barriers to MIST use included lack of consensus amongst clinicians (78%), lack of training (56%), and lack of experience with MIST (56%).
While MIST is being increasingly used in Canadian NICUs, universal use is yet to be seen. Clinician inexperience and lack of consensus, formal training, and local guidelines contribute to underutilization of MIST. Training workshops, country-wide data collection, and uniform operating protocols are needed to standardize practice.
微创表面活性剂治疗（MIST）可用于新生儿重症监护病房（NICU）治疗新生儿呼吸窘迫综合征。全球范围内，MIST的临床应用和机构差异仍然存在，而关于加拿大MIST应用的已发表研究很少。因此，本研究的目的是调查加拿大NICU中MIST的应用情况。
通过电子邮件向加拿大新生儿网络（CNN）循证实践改善质量（EPIQ）肺部健康小组（LHG）的33个参与中心发送在线调查问卷。分类收集机构人口统计学和表面活性剂治疗程序细节。使用自由文本和多项选择题来了解MIST使用中感知到的障碍和个人偏好。
CNN EPIQ-LHG的33名参与成员中有28名在2021年4月至2021年10月期间完成了调查（85%）；17/28（61%）的受访者报告其中心正在使用MIST。大多数使用MIST技术的中心使用牛肺脂质提取物表面活性剂（68%），通常使用血管导管（47%）和专用导管（41%）。MIST广泛用于胎龄26-33周的患者（88%）。9个中心从未使用过MIST（32%），3个中心表示计划在未来2年内实施MIST。MIST使用的常见障碍包括临床医生之间缺乏共识（78%）、缺乏培训（56%）以及缺乏MIST经验（56%）。
虽然MIST在加拿大NICU中的使用越来越多，但尚未普及。临床医生经验不足、缺乏共识、正规培训和当地指南导致MIST使用不足。需要举办培训讲习班、进行全国范围的数据收集并制定统一的操作方案，以规范实践。
