INSURE Uygulanan Preterm Bebeklerin İzleminde İki Farklı Non-İnvaziv Ventilasyon Yönteminin Etkinliğinin ve Komplikasyonlarının Karşılaştırılması

Yıl 2022, Cilt: 1 Sayı: 2, 77 - 83, 27.09.2022

Buse Soysal Senem Alkan Özdemir Tülin Gökmen Yıldırım Şebnem Çalkavur

Öz

Amaç: Respiratuar distres sendromu (RDS), preterm bebeklerde surfaktan eksikliği ve akciğer immaturitesine bağlı gelişen solunum yetmezliğidir. Çalışmamızda; INSURE yöntemiyle surfaktan uygulanan pretermlerin iki farklı non-invaziv ventilasyon yöntemi ile izlemi sırasında kısa ve uzun dönem etkilerin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Çalışmamız Ocak 2016-Aralık 2016 tarihleri arasında yapılan tek merkezli, prospektif, randomize kontrollü bir çalışmadır. İzmir Dr. Behçet Uz Çocuk Hastanesi yenidoğan yoğun bakım ünitesine RDS tanısıyla yatırılıp surfaktan verilen ve gebelik haftası <32 hafta ve/veya doğum ağırlığı 1500 gramın altında olan pretermler çalışmaya dahil edildi. Kapalı zarf usulü ile ventilasyon tipi senkronize nazal aralıklı pozitif basınçlı ventilasyon (SNIPPV) ve nazal sürekli pozitif hava yolu basıncı (NCPAP) olarak randomize edildi. Birincil sonuçlar olarak reentübasyon, apne sıklığı, ek surfaktan gereksinimi, pnömotoraks/ atelektazi gelişimi, gastrik rezidü varlığı kaydedildi. İkincil sonuçları hastaların kapiller kan gazlarındaki parsiyel karbondioksit basıncı (pCO2), oksijen ihtiyacı ve komorbiditeleri oluşturdu.
Bulgular: Çalışmaya SNIPPV grubunda 15, NCPAP grubunda 20 bebek olmak üzere toplam 35 bebek katıldı. Reentübasyon oranı NCPAP grubunda %15, SNIPPV grubunda ise %13.3 iken, gastrik rezidü NCPAP grubunda %35 SNIPPV grubunda %26.6 idi (sırasıyla p>0.05 ve p>0.05). Karşılaştırılan diğer birincil sonuçlar arasında da anlamlı fark bulunamadı (p>0.05). Her iki grupta gelişen komorbiditeler arasında istatistiksel anlamlı fark bulunmadı (p>0.05). SNIPPV grubunda 48. saatte pCO2 düzeyi NCPAP grubundakilerden istatistiksel farka yol açacak şekilde düşüktü (p<0.05). Oksijen gereksinimi SNIPPV grubunda 48. saatte daha düşüktü ve bu fark anlamlıydı (p>0.05) Her iki grupta da mortalite gözlenmedi.
Sonuç: Prematüre bebeklerde INSURE yöntemiyle sürfaktan verilmesi sonrası SNIPPV grubunda NCPAP grubuna göre reentübasyon sıklığı ve 48. saatte oksijen gereksiniminin daha az olduğu, SNIPPV’nin beslenme intoleransı üzerine NCPAP’dan farklı bir negatif etkisi olmadığı gösterilmiştir.

Anahtar Kelimeler

Prematürite;, non-invaziv ventilasyon;, respiratuar distres sendromu

Comparison of Efficiency and Complications of Two Different Non-invasive Ventilation Methods of Preterm Babies Treated with INSURE

Öz

Aim: Respiratory distress syndrome (RDS) is a respiratory failure due to surfactant deficiency and lung immaturity in preterm infants. In our study; we aimed to compare the short-term and long-term effects during the follow-up of preterms who were administered surfactant with the INSURE method with two different non-invasive ventilation methods.
Materials and methods: Our study is a single-center, prospective, randomized controlled study conducted between January 2016 and December 2016. Preterms with a gestational age of <32 weeks and/or a birth weight of less than 1500 grams, who were admitted to the neonatal intensive care unit of Dr Behçet Uz Children's Hospital with the diagnosis of RDS and given surfactant, were included in the study. The ventilation type was randomized to synchronized nasal intermittent positive pressure ventilation (SNIPPV) and nasal continuous positive airway pressure (NCPAP) using the sealed envelope method. Reintubation, apnea, additional surfactant requirement, development of pneumothorax/atelectasis, gastric residue were recorded as primary outcomes. The secondary results were partial pressure of carbondioxide (pCO2) in the capillary blood gases of the patients, oxygen requirement and comorbidities.
Results: A total of 35 infants, 15 in the SNIPPV group and 20 in the NCPAP group, participated in the study. The re-intubation rate was 15% in the NCPAP group and 13.3% in the SNIPPV group, while the gastric residual was 35% in the NCPAP group and 26.6% in SNIPPV group (p>0.05 and p>0.05; respectively). No significant difference was found between the other primary results compared (p>0.05). There was no statistically significant difference between comorbidities in both groups (p>0.05). The pCO2 level at 48th hour in the SNIPPV group was lower than that in the NCPAP group, leading to a statistically significant difference (p<0.05). Oxygen requirement was lower in the SNIPPV group at 48th hour, and this difference was significant (p>0.05). No mortality was observed in either group.
Conclusion: It has been shown that after the administration of surfactant with the INSURE method in premature infants, the frequency of reintubation and oxygen requirement at 48 hours were lower in the SNIPPV group compared to the NCPAP group, and that SNIPPV did not have a different negative effect on feeding intolerance than NCPAP.

Anahtar Kelimeler

: Prematurity, non-invasive ventilation, respiratory distress syndrome

Kaynakça

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