RESPİRATUVAR DİSTRES SENDROMLU PREMATÜRE BEBEKLERDE SURFAKTAN UYGULANMASINDA GÜNCEL METOTLAR

Prematürelerde görülen respiratuvar distres sendromunda surfaktanın klinik kullanıma girmesi ile birlikte prematüre bebeklerdeki yaşam oranı dramatik olarak artmıştır. Surfaktanın akciğerlere iletiminde kullanılan yöntemler zaman içerisinde daha az invaziv ve hatta invaziv olmayan yöntemlere doğru evrilmeye başlamıştır. Surfaktanın ince kateter ile uygulanması, bir larengeal veya suproglottik havayolu cihazı kullanılarak, farengeal uygulama ile ve aerosolize şekilde verilmesi gibi yeni yöntem çalışmaları giderek artmaktadır. Böylece, immatür akciğerin klasik olarak kabul edilen entübasyon, pozitif basınçlı ventilasyon ve mekanik ventilasyonun zararlı etkilerinden korunması hedeflenmiştir. İnce kateter ile surfaktan uygulanması metodu ile yapılan çok sayıda çalışma ve meta-analizin sonuçları entübasyon, surfaktan uygulanması ve pozitif basınçlı ventilasyon metotları ile karşılaştırıldığında mekanik ventilasyon ihtiyacı ve süresi, bronkopulmoner displazi insidansı ve neonatal mortalite oranlarında azalmaya neden olduğu gösterilmiştir. Ancak çalışmalarda premedikasyon yönetimi ve solunum desteği türü, uygulanan surfaktan türü gibi birçok konuda heterojenite mevcuttur. Supraglottik hava yolu cihazı, farengeal uygulama ve aerosolizasyon uygulamaları özellikle laringoskopinin dezavantajlarını ortadan kaldırması ve daha da az invaziv olmaları, daha az tecrübe ve yetenek gerektirmeleri nedenleri ile ince kateter ile surfaktan uygulanması yönteminden avantajlı olsalar da henüz rutin klinik kullanıma girmeleri için daha fazla veriye ihtiyaç vardır.

Anahtar Kelimeler:

Surfaktan, ince kateter surfaktan uygulama, larengeal maske, aerosol, farengeal uygulama

Current Methods for Surfactant Administration in Premature Infants with Respiratory Distress Syndrome

The survival rate of premature infants has increased dramatically, after the beginning of surfactant use in newborn clinics for premature infants with respiratory distress syndrome. The surfactant delivery methods to the lungs have started to evolve into less invasive and even non-invasive methods over the time. Studies on new methods such as thin catheter surfactant administration, laryngeal or supraglottic airway device, pharyngeal instillation, and aerosolized techniques are increasing. The purpose of the less invasive or noninvasive methods is the protection of immature lungs from harmful effects of intubation, positive pressure ventilation and invasive mechanical ventilation. It has been reported in many studies and meta-analysis that TCA methods were related to lower need of mechanical ventilation, shorter duration of mechanical ventilation, and lower incidence of bronchopulmonary dysplasia or death, compared to intubation, surfactant, and positive pressure ventilation methods. However, there are heterogeneities in premedication policies and respiratory support type, and the type of surfactant applied in the studies. Laryngeal or supraglottic airway device, pharyngeal instillation, and aerosolized techniques have advantages over thin catheter, because they eliminate the disadvantages of laryngoscopy, they are less invasive than thin catheter and they require minimal experience and skills, but more data are needed for routine clinical use of these new methods.

Keywords:

Surfactant, thin catheter surfactant administration, laryngeal mask, aerosol, pharyngeal instillation.,

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