Clinical Predictors for Outcome of Continuous Positive Airway Pressure in Respiratory Distress Syndrome in Preterms: Single Center Study

Amira M Sabry, R. Saber, D. Khairy, A. Edris, M. El-Baz
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引用次数: 1

Abstract

Background: Applying mechanical ventilation (MV) to premature lungs carries many risks, up to lung injury and bronchopulmonary dysplasia. Stabilization with continuous positive airway pressure (CPAP) avoids intubation and invasiveness. Aim of work: To evaluate the predictors of outcome of nasal CPAP on preterms with respiratory distress syndrome (RDS). Material and Methods: This prospective observational study included all preterms with RDS that necessitated CPAP introduction (according to the European Consensus Guidelines on the Management of RDS), who were admitted to the Neonatal Intensive Care Unit (NICU) of Department of Pediatrics, Cairo University Hospitals, from February to July 2019. CPAP was initiated in the first 2 hours of life. Respiratory compromise was assessed using Silverman score. Hematological scoring system (HSS) was studied as a predictor of outcome. Those who did not need subsequent intubation were labeled CPAP success group and were compared to the group where CPAP failed. Results: Over 6-months, 508 preterm with gestational age (GA) 27-33 weeks with RDS were admitted to our NICU, of them 61 (mean GA± SD of 32.08 ± 1.98 weeks) were included in the study. Of them 35 (57.4%) were males and 26 (42.6 %) females. CPAP was successful in 37 (60.7%) and Silverman score improved 2 hours after CPAP. Their initial median (IQR) of Silverman score was 5 (range 3-6) and improved to 1 (range 1-2) 2 hours after CPAP, while in the failure group, it was 6 (range 5-7) initially and worsened to 8 (range 7.5-9) (p=0.026). Antenatal steroids administration was highly protective (p= 0.000) but not GA p=0.086) or gender (p=0.521). Initial severe RDS in chest X-ray at birth was present in 1 (2.7 %) preterm in the CPAP success group and 10 (41.7 %) in the failure group (p=0.000). The systolic blood pressure ≤ 66, HSS, chest X-ray before CPAP, non-improvement of chest X-ray after CPAP and apnea were the important predictors for CPAP failure (p= 0.023), (p= 0.090), (p= 0.025), (p= 0.011) and (p= 0.049) respectively. Conclusion: Trials of CPAP for preterms with severe RDS with hemodynamic stability are effective in obviating the need for more invasive MV. Factors including hypercarbia, apnea, poor respiratory efforts, systemic hypotension, higher Silverman score and HSS ≥5 were the most significant associations of failed CPAP. Level of Evidence of Study: IIA (1).
持续气道正压治疗早产儿呼吸窘迫综合征预后的临床预测因素:单中心研究
背景:在早产儿肺中应用机械通气(MV)存在许多风险,包括肺损伤和支气管肺发育不良。持续气道正压通气(CPAP)稳定可避免插管和侵入性。工作目的:探讨鼻腔CPAP治疗早产儿呼吸窘迫综合征(RDS)预后的预测因素。材料和方法:这项前瞻性观察性研究纳入了2019年2月至7月在开罗大学医院儿科新生儿重症监护病房(NICU)住院的所有需要引入CPAP的RDS早产儿(根据欧洲RDS管理共识指南)。CPAP在出生后2小时开始。采用Silverman评分法评估呼吸损害。研究了血液学评分系统(HSS)作为预后预测因子。不需要后续插管的患者被标记为CPAP成功组,并与CPAP失败组进行比较。结果:6个月以上新生儿重症监护病房共收治508例胎龄27 ~ 33周的RDS早产儿,其中61例(平均GA±SD 32.08±1.98周)纳入研究。其中男性35例(57.4%),女性26例(42.6%)。CPAP成功37例(60.7%),术后2小时Silverman评分提高。他们的初始中位(IQR) Silverman评分为5(范围3-6),在CPAP后2小时改善到1(范围1-2),而失败组最初为6(范围5-7),恶化到8(范围7.5-9)(p=0.026)。产前类固醇给药具有高度保护作用(p= 0.000),但对GA (p= 0.086)和性别(p=0.521)没有保护作用。CPAP成功组早产1例(2.7%),失败组早产10例(41.7%)(p=0.000)。收缩压≤66、HSS、CPAP前胸片、CPAP后胸片无改善和呼吸暂停分别是CPAP失败的重要预测因素(p= 0.023)、(p= 0.090)、(p= 0.025)、(p= 0.011)和(p= 0.049)。结论:CPAP治疗严重RDS且血流动力学稳定的早产儿可有效避免更有创性的MV。高碳化、呼吸暂停、呼吸困难、全身性低血压、较高的Silverman评分和HSS≥5是CPAP失败的最显著相关因素。研究证据等级:IIA(1)。
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