Respiratuvar Distres Sendromunda Yeni Grsler

1
Respiratuvar Distres Sendromunda Yeni Görüsler

• Yrd. Doç. Dr. S.Ümit Sarici

2
Etiyopatogenez
PPROM-RDS Iliskisi

• Sims EJ, et al. Preterm premature rupture of the
  membranes is associated with a reduction in
  neonatal respiratory distress syndrome. Am J
  Obstet Gynecol 2002 187 268-272.

3
Surfaktan protein B polimorfizmi
Etiyopatogenez

• Floros J, et al. Surfactant protein (SP) B
  associations and interactions with SP-A in white
  and black subjects with respiratory distress
  syndrome. Pediatr Int 2001 43 567-576.

4
Oksidan stres, antioksidan yetersizlik ve RDS
Etiyopatogenez

• Gitto E, et al. Respiratory distress syndrome in
  the newborn role of oxidative stress. Intensive
  Care Med 2001 27 1116-1123.

5
Reverse end-diastolic umbilikal arter akimi ile
RDS iliskisi
Tani

• Muller T, et al. Arterial and ductus venosus
  Doppler in fetuses with absent or reverse
  end-diastolic flow in the umbilical artery
  correlation with short-term perinatal outcome.
  Acta Obstet Gynecol Scand 2002 81 860-866.

6
Akciger grafisi bulgulari
Tani

• Carey BE. Chest x-ray findings in respiratory
  distress syndrome. Neonatal Netw 2000 19 40-45.

7
Diüretik (furosemid) tedavisi
Tedavi

• Brion LP, Soll RF. Diuretics for respiratory
  distress syndrome in preterm infants. Cochrane
  Database Syst Rev 2000 (2) CD001454.

8
Erken CPAP uygulamasi ? IPPV ihtiyaci ?
Mortaliteye etkisi ? Pnömotoraks riski
Tedavi

• ? Ho JJ, et al. Continuous distending pressure
  for respiratory distress syndrome in preterm
  infants. Cochrane Database Syst Rev 2002 (2)
  CD002271.
• ? Ho JJ, et al. Early versus delayed initiation
  of continuous distending pressure for
• respiratory distress syndrome in preterm
  infants. Cochrane Database Syst Rev 2002 (2)
  CD002975.

9
Erken surfaktan, ekstubasyon ve nazal CPAP
uygulamasi ? IPPV süresi? Mortalite ?
PDA sikligi ? Surfaktan miktari
Tedavi

• Stevens TP, et al. Early surfactant
  administration with brief ventilation vs
  selective surfactant and continued mechanical
  ventilation for preterm infants with or at risk
  for RDS. Cochrane Database Syst Rev 2002 (2)
  CD003063.

10
Profilaktik veya selektif surfaktan
uygulamasi ? RDS sikligi ve seyri ?
Pnömotoraks riski? PIE ve BPD riski
? Genel ve surfaktana bagli mortalite
Tedavi

• Soll RF, Morley CJ. Prophylactic versus selective
  use of surfactant in preventing morbidity and
  mortality in preterm infants. Cochrane Database
  Syst Rev 2001 (2) CD000510.

11
Dogal veya sentetik surfaktan uygulamasi?
Mortalite ? IPPV süresi ?
Pnömotoraks riski ? Grade I ve II
IVK riski
Tedavi

• Soll RF, Blanco F. Natural surfactant versus
  synthetic surfactant for neonatal respiratory
  distress syndrome. Cochrane Database Syst Rev
  2001 (2) CD000144.

12
iki farkli dogal surfaktan preparati?
Mortalite ? IVK ve NEK sikligi
Tedavi

• Clark RH, et al. A comparison of the outcomes of
  neonates treated with two different natural
  surfactants. J Pediatr 2001 139 828-831.

13
Agir hipoksemik RDSde tolazolin tedavisi
Tedavi

• Nuntnarumit P, et al. Efficacy and safety of
  tolazoline for treatment of severe hypoxemia in
  extremely preterm infants. Pediatrics 2002 109
  852-856.

14
RDSde HFO veya konvansiyonel mekanik ventilasyon
Tedavi

• Johnson AH, et al. High-frequency oscillatory
  ventilation for the prevention of chronic lung
  disease of prematurity. N Engl J Med 2002 347
  633-642.
• Courtney SE, et al. High-frequency oscillatory
  ventilation versus conventional mechanical
  ventilation for very-low-birth-weight infants. N
  Engl J Med 2002 347 643-652.
• Merchak A, et al. Endogenous pulmonary surfactant
  metabolism is not affected by mode of ventilation
  in premature infants with respiratory distress
  syndrome. J Pediatr 2002 140 693-698.
• Gerstman DR, et al. Childhood outcome after early
  high-frequency oscillatory ventilation for
  neonatal respiratory distress syndrome.
  Pediatrics 2001 108 617-623.

15
Tidal volume-guided ventilation
Tedavi

• Cheema IU, Ahluwalia JS. Feasibility of tidal
  volume-guided ventilation in newborn infants a
  randomized crossover trial using the volume
  guarantee modality. Pediatrics 2001 107
  1323-1328.