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Less invasive surfactant Application - Pro
Angela Kribs, Köln (DE)
Tuesday, Jan. 16, 2018 · 11:33 a.m. · 17m 00s
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i kind introduction and thank you very much also for the invitation uh giving
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me support opportunity to speak about this issue uh i'm on this meeting
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and i've been trying to get my presentation and first i will
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give some sorts about background why it could be useful
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to introduce leas are then i weighted presence on data and
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based on the data i will give my conclusions
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the the beam is not working yet so maybe you could the there was a few jokes
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so i i i i think i can also um
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speaker um well without the first slides and to
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um give my sorts about a background vie
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lee sites who can can be useful first of all i think that's a application
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of surfactant we and and that kind of you know cheap it's um in a historical
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famine mean yeah s. set that was introduced into the c. r. p. off
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preterm infants these are yes most preterm infants very very very
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basic and say where are already d. twenty late incubate
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it into when can eighty to due with two other reasons then there is a tory into fiction see
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and to let's say introduction off um of surfactant into the
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c. or p. um is um mortality rates decreased
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and it's this loser halted also you know much more
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active and management of soft stated shuns resulting in
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mm preterm babies i'm coming to us it's neon apologised with
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um the um one finds all the tele t.
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and to sell our uh move an actor
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the observation is that most babies um
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after bus starts spontaneous precinct and um was
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is that right or that for say do
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not need obligatory incubation and mechanical ventilation
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and that's in a set places that we have learned during the
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last he has a t. kate set as a spontaneous perhaps
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not a patterns of spawn the of policing are very important foreman
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record plant so baby after bus starts lisa some deep
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but he sings was an end expert to revolt and margo really
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co yeah i already has shown that this happens of policing
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not important for the um direction off that are and we
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should not disturb this spontaneous cartons of policing by incubation
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and mechanical ventilation and the larynx plays an important role in this
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recruitment immediately after plus and we should be awards that
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initial patient as a kind of your trucking nick using yesterday
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nick are going to take a lot of the larynx
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and uh and therefore mechanical ventilation and incubation can infuse
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long in pure really and can just chops the
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spontaneous mechanisms for non recruitment and they're full of
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therefore to my opinion say should be avoided
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and we also know it's a long in general you can use brain lesions
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and if we want to take care for the p. make sure baby
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v. should anymore on avoidance of plane he since s. i. s. line
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actually and that those are for mechanical ventilation should be avoided if
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he can possibly and um it nowadays we know all from several
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prospective randomised control trials that c. pap s. s. primarily to start oh it
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support is the safe alternative to into patient and mechanical ventilation backed
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we know sets the outcome is comparable this use of c.
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pop s. parameter list a total support but not
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factor in all aspects spindle fight samples it say put the c. pap it's related to high rate of
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non majority's and we know on the on line and
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also that's effect in um you also earlier
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related to integration and mechanical ventilation what's
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the tracks it improved the outcome of
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preterm infants more than any of
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us yeah b. and therefore say the ideas it's affected with out
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any make and couldn't care ventilation and into patient but with
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see that may be is a combination of two highly
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a second effective principals and says i'd yeah it's not all not knew what and you
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see that uh oh different moulds of mini
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mellow or less invasive surfactant applications
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that were described during the last d. kate's and one of them it's it's a
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foreign you'll administration that was already described in
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the already only ninety nine teens
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a more new idea it's a application v. um
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and and having your mask says is limited to a
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to a bigger infants because uh of technical reasons
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some mozilla germs multiply to be is a police station of surfactant
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but we all know was it until nowadays it has
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a technical term problems tool um the policy effect and and
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so it's a so high a um to embrace of
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stands and so uh idea of us to um to re activates
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the idea of yeah that call aches and described first in
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nineteen ninety two to abdicate seven checked into yes scene and the
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trial 'cause you know during spontaneous piecing we sit c.
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type support and um i i started to uh to do it
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and in two thousand one in um very tiny baby physical
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station age of twenty three weeks after pretty make show rupture
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of membranes his ninety peaks of institutional eight and the
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parents had around yeah i'm ambivalent to to say you wanted to
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do nothing against the baby but say it was wanted also
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to avoid it in they receive intensive care and the baby
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was born very return of this is a normal um
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heart rate and to spontaneous precinct but detects um high difficulties um
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invokes you can nation the and so on um in
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um after speaking disappearance i decided to try says approaches is
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intent anticipate is survive without my of complications interest hours
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anyway and give mechanical ventilation you reams of hospital state and that was
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the reason for us to start with is is this mess
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that s. observation the feasibility study thursday and it took a long
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time to get it really should also be start it
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was all white tensions in the attempts to publish it into solvents
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leave but it uh it uh it lasted until two thousand
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seven hundred it was accepted and that's the first presentation was followed
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by first observation of studies and and all its own
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by observations start it's with us a little bit to modify it
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um the way to to to to put to death
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the principle is the installation of a scene in the trial
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cassie ten surfactant application b. s. diskette you that
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we see pop support to spontaneous precinct entry decay to
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bass says uh uh visualisation um of the
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vocal chord urine lauren was copied and then placing those uh can see toby yes the use of the
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make a fart this is our mindset and this mess
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it um was uh evaluate it in several
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observations studies and this is the first published observation and start
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it into sees actually country use as a mechanic
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to write and um there's a and as he the i. v. h. and supplementary intends to see
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a infuse him up by introducing this mess it and
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and that every uh it collects would be fired
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as a mess it sort of sets they use the more we could get it up and
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could place a classical with out making forceps and say
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observed similar at effects as we enter as if these first um to um
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but ah it's false um followed by some observations studies and seven
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are consistent finding findings regarding efficacy and says findings of a
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a decrease of f. i. tool and the standing price after the
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pro today are less need for into patient during uh
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the first seventy two howard compared to historical controls and to train to shorter
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duration of different kinds of us but also support and it's actually in
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the very tiny inference is a good station the age below twenty six
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week you know what's that is a lot l. e. d. and
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no right of c. b. i. d. h. and low right of yeah leaks that is correct
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i was yeah i also some side effects and say well
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also cause insistently uh described in or observation of studies
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this was the need for mars and how one had tend to be successful in the placement
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of the conceit up the need for positive pressure ventilation be a mask after the put
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she'd your as a consequence of what kept me out of the baby practicality uh or the
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separation also in some cases need to um
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to beings are reason fall off or
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positive pressure ventilation dislocation of the capital of the
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fact that freaks but all this five effects
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are on the one side depending on the experience with the method and decrease in
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separate peace corps we experience in the centre and the on the eye and say can
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be very good to manage to this short periods of um ventilation yeah i'm ask
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and this is not observation and they have are followed by an teen
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now was six completed prospective randomised controlled trials you do not
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need and uh have a need to read this uh this things
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but i wanted to all uh only two mentions the six
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i'm already completed tryouts further trials are ongoing
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and it's it's um try it's um uh uh
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until now we included in some meta analysis
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one of these men to uh analysis it's it's neck to document analysis by say
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yeah my who compact different strategies to prevent the p. d. and and and
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would you mean prevent mortality in the um preterm infants um and
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um it's it's it's a it's a mess it's just imitating
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is comprised of the effects of or interventions on the outcome
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might be like competition and my estimation of indirect effects
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and and we were not a a files and
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risk estimation of the effect of single interventions
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and it's it's about to sell 'em as the interesting or not
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concerning the that was that liza what's um
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compared to or other strategies like mechanical ventilation nasal c. at all
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you should lock the method that resulted in so
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strong as production of tests or p. p. e. so uh that's the conclusion of the also is is
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that lisa is uh i'm i'm not a problem it's it's um i
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um strategy to prevent mortality and morbidity
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in preterm infants enjoy if
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you have a big net one in that all the um or
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a clinical take us of instances of get a bus right
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below thousand five hundred grams and our report it and from this network
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uh um what can good good beaten them a match yeah
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analysis comparing a thousand one hundred and three intensely c. v. d.s
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out this is what i'm i'm the same number of
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receiving 'em ascetic country and and look crappy out you'll and the uh um
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i thought of this um makes yeah analysis but it and b.
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p. d. s. m. l. s. u. s. or p. p. e. was
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significantly used in the group of b. b. c. c. d.'s that
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and uh i'm right interesting is said to see affects said we can observe is
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different for um in terms with a guess it differently station eight four
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babies with the i guess dictionary lay of more than twenty five completed the
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mean effect is sorry action of the need of mechanical ventilation is
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for ah in terms of as a guest external age of lois and twenty five
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weeks mean effects a retraction of s. or e. so set for this very
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tiny baby it's um he's on may be
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estimated use it also um him makes
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possible to survive in infants who um die it was i thought efforts
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and and to my opinion it is she has that for the short term outcome these are
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has the impact two groups outcome of the infants but there is there's a question was is what is this a
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long term outcome and to be didn't examination of all four
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first um ups every day uh observation is study
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in the nature of um five to six yes and that uh what you can see
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is that in the intentional core out we had this was a comparable i'm lost
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follow up we had a really you just small tele t. how on t.
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s. s. h. and we had a really you was to um
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so why the voice mail complications i'm at my your disability and a
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higher rate of in terms of driving these out any um
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a disability so say perhaps also we got them so long
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term out get out companies out could be in fiction
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and this is our area recent data from the
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german neonatal networks the base insignia nathan
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it network uh also x. amount in the age of five to six yes
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and since it's a uh huh and say is out of that out of the uh
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line function is six years and use sees that the rate of pay saving a
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um a long function um it's highlights are
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integral of babies with seats effect to
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be as you send in support who was he be too yeah these are
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and uh so i'm i'm very convinced that he's are in an approach um
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that um maybe with the outcome of preterm infants is our d. s.
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um actually is the ah ha uh still a lot of questions guns or
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concerning the those um practical mess it it takes to be a and
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m. a. to start it in in in our no mice to uh
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trials but i'm i'm convinced that it's it is was to secure
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it
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thank you very much for this very clear talk and we would like to move on
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