Title Nove smjernice u liječenju respiratornog distres sindroma
Title (english) New guidelines in respiratory distress syndrome treatment
Author Ana Habjanec
Mentor Ruža Grizelj (mentor)
Committee member Jurica Vuković (predsjednik povjerenstva)
Committee member Marija Jelušić (član povjerenstva)
Committee member Ruža Grizelj (član povjerenstva)
Granter University of Zagreb School of Medicine Zagreb
Defense date and country 2017-07-14, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Intensive Care
Abstract Respiratorni distres sindrom (RDS) je klinički sindrom kojeg karakterizira respiratorno zatajenje zbog nedostatka plućnog surfaktanta i strukturne nezrelosti pluća, a javlja se uglavnom u prijevremeno rođene djece.
Simptomi bolesti javljaju se neposredno pri rođenju ili unutar par sati i progrediraju tijekom prva dva dana života . Ukoliko se pravovremeno ne primijeni adekvatno liječenje može nastupiti smrt zbog progresivne hipoksije i zatajenja disanja.
Klinički se RDS manifestira pojavom tahipneje, dispneje sve do apnoičkih kriza, aktivacijom pomoćne dišne muskulature uz ekspiratorno stenjanje i centralnu cijanozu.
Dijagnoza RDS-a može se postaviti obično u prvim minutama ili satima nakon poroda, a temelji se na anamnestičkim podacima o tijeku trudnoće i poroda, kliničkoj slici novorođenčeta, auskultacijskom nalazu na plućima, plinskoj analizi krvi i rentgenogramu srca i pluća na kojoj se ističu tzv. “mliječna pluća“ uz jasno izražen aerobronhogram.
Razvojem prenatalne i perinatalne medicine značajno je smanjena smrtnost uzrokovana RDS-om. Prenatalna primjena kortikosteroida dokazano ubrzava proces sazrijevanja pluća i sprječava nastanak bolesti. Nedonoščad, osobito ona rođena prije 32. tjedna gestacije trebala bi biti rođena u tercijarnim centrima gdje se može osigurati sveobuhvatna zdravstvena skrb koja uključuje mogućnosti i vještine potrebne za stabilizaciju i primarno zbrinjavanje, respiratornu potporu, kao i primjenu surfaktanta.
Dosadašnji „zlatni standard“ u liječenju RDS-a podrazumijevao je endotrahealnu intubaciju, primjenu surfaktanta i mehaničku ventilaciju.
Prema najnovijim smjernicama rana primjena nCPAP-a omogućuje odgađanje, a u velikom broju i izbjegavanje mehaničke ventilacije. Kod novorođenčadi s blažim oblikom RDS-a može doći do oporavka i bez primjene surfaktanta ukoliko se nCPAP primjenio neposredno po porodu.
Abstract (english) Respiratory distress syndrome (RDS) is a condition of pulmonary insufficiency due to lack of lung surfactant and structural immaturity of the lung, and it occurs mainly in premature babies. Pulmonary insufficiency begins to manifest immediately at birth or within a few hours after birth and it progresses during the first two days of a newborn life. If proper treatment is not timely applied, death can occur due to progressive hypoxia and respiratory failure.
Clinically, RDS is manifested by the occurrence of tachipnea, dyspnoea and apnoic crises, with activation of accessory respiratory muscules with exhalative grunting and central cyanosis. The diagnosis of RDS may usually be set in the first minutes or hours after delivery, based on patient history data on pregnancy and childbirth, clinical presentation, lung findings, gas analysis of the blood and the x-ray image in which the so-called. "Milk Lung" can be seen with a clearly expressed aerobronhogram.
The development of prenatal and perinatal medicine has significantly reduced the mortality rate caused by RDS. Prenatal application of corticosteroids has been shown to accelerate the lung growth process and prevent the onset of the disease. Premature born babys, especially those under 32 weeks of gestation, should be born in centers where tertiary health care can be provided, which includes the capabilities and skills needed for stabilization and primary care, respiratory support and surfactant application.
Until resently the "golden standard" in treating RDS was endotracheal intubation, surfactant application and mechanical ventilation.
According to the latest guidelines of early application of nCPAP, it is possible to postpone, in a large number, and avoid mechanical ventilation. In newborns with milder RDS, recovery can be achieved without the use of surfactant if nCPAP is applied immediately after birth.
Keywords
Respiratorni distres sindrom (RDS)
surfaktant
nazalni kontinuirani pozitivni tlak u dišnim putovima (nCPAP)
Keywords (english)
Respiratory distress syndrome (RDS)
surfactant
nasal continuous positive airway pressure (nCPAP)
Language croatian
URN:NBN urn:nbn:hr:105:203332
Study programme Title: Studies in Nursing Study programme type: university Study level: graduate Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2018-03-19 13:51:06