Abstract
BackgroundLung recruitment is a maneuver used to decrease the length of intubation in preterm neonates. This study aimed to compare the therapeutic efficacy of lung recruitment plus intubation-surfactant-extubation (INSURE) procedure and INSURE alone for the preterm neonates with respiratory distress syndrome.MethodsFrom 2017 to 2019, 184 preterm neonates (gestational age 24–32 weeks) with respiratory distress syndrome were enrolled and randomized into the lung recruitment group receiving lung recruitment (25 cm H2O, 15 s) plus INSURE and the control group receiving INSURE only. The primary outcome was the need for mechanical ventilation (MV) within 72 h after extubation. The secondary outcomes included duration of MV, noninvasive ventilation, total oxygen therapy, hospitalization time, and complications.ResultsCompared to the control group, the lung recruitment group had a significantly lower proportion of preterm neonates requiring MV within 72 h after extubation (23% vs. 38%, P = 0.025) and pulmonary surfactant administration, as well as a shorter MV duration. There was no significant difference in the incidences of complications (all P > 0.05) and in-hospital mortality (2% vs. 4%, P = 0.4) between the lung recruitment group and control group. Multivariate logistic regression analysis demonstrated that the control group had a 2.17-time higher risk of requiring MV than the lung recruitment group (AOR: 2.17, 95% CI: 1.13–4.18; P = 0.021). Compared with infants with a normotensive mother, infants with a hypertensive mother have a 2.41-time higher risk of requiring MV (AOR: 2.41, 95% CI: 1.15–5.05; P = 0.020).ConclusionLung recruitment plus INSURE can reduce the need for MV within 72 h after extubation and did not increase the incidence of complications and mortality.Trial registrationChinese Clinical Trial Registry ChiCTR1800020125, retrospectively registered on December 15, 2018.
Highlights
Lung recruitment is a maneuver used to decrease the length of intubation in preterm neonates
The INSURE technique consists of an INtubation-SURfactant-Extubation procedure, which can reduce the need for mandatory ventilation (MV) and, the duration of respiratory support in preterm infants with respiratory distress syndrome (RDS) [4]
Patients’ demographic and clinical characteristics A total of 184 preterm neonates with RDS were randomized into the lung recruitment group which received lung recruitment plus INSURE and the control group which received INSURE only (n = 92 for each group)
Summary
Lung recruitment is a maneuver used to decrease the length of intubation in preterm neonates. This study aimed to compare the therapeutic efficacy of lung recruitment plus intubation-surfactant-extubation (INSURE) procedure and INSURE alone for the preterm neonates with respiratory distress syndrome. According to the European Consensus Guidelines for the Management of RDS, preterm infants should receive Continuous positive airway pressure (CPAP) of at least 6 cm H2O via mask or nasal prongs to stabilize spontaneously breathing [2]. The European Consensus Guideline suggests that INSURE strategy should be considered for infants who failed in CPAP treatment [3]. The INSURE technique consists of an INtubation-SURfactant-Extubation procedure, which can reduce the need for mandatory ventilation (MV) and, the duration of respiratory support in preterm infants with RDS [4]
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