Abstract：
BACKGROUND: Laser retinopexy is the current standard treatment for babies with type I retinopathy of prematurity (ROP). No guidelines exist for respiratory management during this procedure. Although neonatologists prefer to avoid intubation to prevent delays in extubation, feeding and discharge, ophthalmologists often request intubation, because sedation alone may lead to respiratory collapse. Little evidence is available regarding which treatment provides the most benefit to vulnerable infants.
OBJECTIVE: This study investigated relevant associations or underlying conditions that may help guide decision-making in respiratory management during laser retinopexy.
METHODS: A retrospective chart review was performed to analyze data from babies who underwent retinopexy from 2006 to 2011 at the Montefiore Medical Center. The main outcome measures included respiratory support before, during and after laser therapy; time from treatment to extubation; and time from treatment to discharge.
RESULTS: The main outcomes were analyzed in four groups: never intubated (n = 27), emergently intubated (n = 7), already intubated (n = 8) and electively intubated (n = 28). No significant differences were observed in the number of pre-operative apneic/bradycardic events, postoperative time to extubation, time to discharge and delays in feeding among groups.
CONCLUSIONS: No specific comorbid conditions were found to predict a need for intubation. Elective intubation did not cause delays in feedings, extubation or discharge. A selective approach to respiratory support would result in 20% of initially non-intubated patients requiring emergent intubation.
OBJECTIVE: This study investigated relevant associations or underlying conditions that may help guide decision-making in respiratory management during laser retinopexy.
METHODS: A retrospective chart review was performed to analyze data from babies who underwent retinopexy from 2006 to 2011 at the Montefiore Medical Center. The main outcome measures included respiratory support before, during and after laser therapy; time from treatment to extubation; and time from treatment to discharge.
RESULTS: The main outcomes were analyzed in four groups: never intubated (n = 27), emergently intubated (n = 7), already intubated (n = 8) and electively intubated (n = 28). No significant differences were observed in the number of pre-operative apneic/bradycardic events, postoperative time to extubation, time to discharge and delays in feeding among groups.
CONCLUSIONS: No specific comorbid conditions were found to predict a need for intubation. Elective intubation did not cause delays in feedings, extubation or discharge. A selective approach to respiratory support would result in 20% of initially non-intubated patients requiring emergent intubation.
摘要：
背景：激光视网膜固定术是目前早产儿I型视网膜病变（ROP）婴儿的标准治疗方法。在此过程中，没有呼吸管理指南。虽然新生儿科医师更喜欢避免插管以防止拔管延迟，喂食和放电，眼科医生经常要求插管，因为单独使用镇静剂可能导致呼吸衰竭。关于哪种治疗对弱势婴儿最有益的证据很少。
目的：本研究调查了可能有助于指导激光视网膜固定术期间呼吸管理决策的相关关联或潜在条件。
方法：回顾性分析了2006年至2011年在蒙特菲奥雷医疗中心接受视网膜固定术的婴儿的数据。主要结局指标包括之前的呼吸支持，激光治疗期间和之后；从治疗到拔管的时间；从治疗到出院的时间。
结果：分析了四组的主要结果：从未插管（n=27），紧急插管（n=7），已经插管（n=8）和选择性插管（n=28）。术前呼吸暂停/心动过缓事件的数量没有显着差异。术后拔管时间，出院时间和各组喂养延迟。
结论：没有发现特定的共病条件可以预测插管的需要。选择性插管不会导致喂养延迟，拔管或出院。选择性的呼吸支持方法将导致20％的最初未插管的患者需要紧急插管。
目的：本研究调查了可能有助于指导激光视网膜固定术期间呼吸管理决策的相关关联或潜在条件。
方法：回顾性分析了2006年至2011年在蒙特菲奥雷医疗中心接受视网膜固定术的婴儿的数据。主要结局指标包括之前的呼吸支持，激光治疗期间和之后；从治疗到拔管的时间；从治疗到出院的时间。
结果：分析了四组的主要结果：从未插管（n=27），紧急插管（n=7），已经插管（n=8）和选择性插管（n=28）。术前呼吸暂停/心动过缓事件的数量没有显着差异。术后拔管时间，出院时间和各组喂养延迟。
结论：没有发现特定的共病条件可以预测插管的需要。选择性插管不会导致喂养延迟，拔管或出院。选择性的呼吸支持方法将导致20％的最初未插管的患者需要紧急插管。
