Nove smjernice u liječenju respiratornog distres sindroma

master's thesis

• Title (english): New guidelines in treatment of respiratory distress syndrome
• Author: Iva Lukač
• 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; (Department of Pediatrics); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Respiratorni distres sindrom (RDS) je klinički sindrom kojeg karakterizira respiratorno zatajenje nastalo interakcijom strukturne nezrelosti pluća i manjka i nezrelosti plućnog surfaktanta u prijevremeno rođene djece. Naziva se i hiposurfaktozom, a nekada su je nazivali i hijalinomembranskom bolešću zbog njezine patoanatomske slike. ----- Dijagnoza RDS-a temelji se na prisustvu kliničkih znakova kao što su tahipneja, dispneja, aktivacija pomoćne dišne muskulature, stenjanje i centralna cijanoza, radiološkog nalaza srca i pluća na kojem se vidi retikulogranularni crtež, slika mliječnog stakla s aerobronhogramom te analize plinova u krvi. ----- Razvojem neonatalne medicine posljednjih desetljeća značajno je smanjena smrtnost zbog RDS-a. Prenatalna primjena kortikosteroida dokazano ubrzava sazrijevanje pluća te sprječava nastanak bolesti. Prema najnovijim smjernicama terapijska strategija temelji se na neivazivnom liječenju primjenom nCPAP-a odmah nakon rođenja. Takav način liječenja dokazano je bolji od dosadašnjeg zlatnog standarda koji je podrazumijevao endotrahealnu intubaciju, profilaktičku ili selektivnu primjenu surfaktanta te mehaničku ventilaciju.

Abstract (english)

Respiratory distress syndrome (RDS), formerly known as hyaline membrane disease, occurs in incompletely developed lungs and is, therefore, primarily a disease of preterm neonates. Immature lungs are functionally deficient in mature surfactant. ----- Lung atelectasis leads to ventilation-perfusion disorder, hypoxia, and eventual respiratory failure in the untreated infant who has RDS. A preterm infant must have clinical signs of respiratory distress, which are tachypnea, nasal flaring, chest wall retractions, expiratory grunting and central cyanosis, and a classic chest radiograph that shows diffuse atelectasis and the classic „ground glass“ appearance of the lung fields, to be diagnosed with RDS. ----- Antenatal steroids are believed to decrease the incidence of RDS by accelerating maturation of the fetal lung. Surfactant replacement therapy has been approved for use since 1990 and has been successful in decreasing rates of RDS. In general, prophylactic use of surfactant is recommended over rescue treatment in infants at high risk for developing RDS. The push toward use of less invasive ventilation strategies in the treatment of the RDS has led to several trials of nasal continues positive airway pressure (CPAP). The most current evidence supports the strategy of early CPAP, initiated at birth, with rescue surfactant therapy if indicated. That strategy appears to be superior to prophylactic intubation, surfactant administration and ventilation in preterm infants.

• 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:105:769415
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-04-11 10:34:38