Intratracheal Atomized Surfactant Provides Similar Outcomes As Bolus Surfactant in Preterm Lambs with Respiratory Distress Syndrome

Overview

Journal Pediatr Res

Specialties Biology
Pediatrics

Date 2016 Mar 9

PMID 26954481

Citations 11

Authors

Ilaria Milesi

David G Tingay

Emanuela Zannin

Federico Bianco

Paolo Tagliabue

Fabio Mosca

Anna Lavizzari

Maria Luisa Ventura

C Elroy Zonneveld

Elizabeth J Perkins

Don Black

Magdy Sourial

Raffaele L Dellaca

Affiliations

Soon will be listed here.

Abstract

Background: Aerosolization of exogenous surfactant remains a challenge. This study is aimed to evaluate the efficacy of atomized poractant alfa (Curosurf) administered with a novel atomizer in preterm lambs with respiratory distress syndrome.

Methods: Twenty anaesthetized lambs, 127 ± 1 d gestational age, (mean ± SD) were instrumented before birth and randomized to receive either (i) positive pressure ventilation without surfactant (Control group), (ii) 200 mg/kg of bolus instilled surfactant (Bolus group) at 10 min of life or (iii) 200 mg/kg of atomized surfactant (Atomizer group) over 60 min from 10 min of life. All lambs were ventilated for 180 min with a standardized protocol. Lung mechanics, regional lung compliance (electrical impedance tomography), and carotid blood flow (CBF) were measured with arterial blood gas analysis.

Results: Dynamic compliance and oxygenation responses were similar in the Bolus and Atomizer groups, and both better than Control by 180 min (all P < 0.05; two-way ANOVA). Both surfactant groups demonstrated more homogeneous regional lung compliance throughout the study period. There were no differences in CBFConclusion:In a preterm lamb model, atomized surfactant resulted in similar gas exchange and mechanics as bolus administration. This study suggests evaluation of supraglottic atomization with this system when noninvasive support is warranted.

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References

Lewis J, Ikegami M, Jobe A, Tabor B . Aerosolized surfactant treatment of preterm lambs. J Appl Physiol (1985). 1991; 70(2):869-76. DOI: 10.1152/jappl.1991.70.2.869. View

Tingay D, Polglase G, Bhatia R, Berry C, Kopotic R, Kopotic C . Pressure-limited sustained inflation vs. gradual tidal inflations for resuscitation in preterm lambs. J Appl Physiol (1985). 2015; 118(7):890-7. PMC: 4459928. DOI: 10.1152/japplphysiol.00985.2014. View

Ellyett K, Broadbent R, FAWCETT E, Campbell A . Surfactant aerosol treatment of respiratory distress syndrome in the spontaneously breathing premature rabbit. Pediatr Res. 1996; 39(6):953-7. DOI: 10.1203/00006450-199606000-00005. View

Polglase G, Tingay D, Bhatia R, Berry C, Kopotic R, Kopotic C . Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs. BMC Pediatr. 2014; 14:43. PMC: 3937019. DOI: 10.1186/1471-2431-14-43. View

Dysart K, Miller T, Wolfson M, Shaffer T . Research in high flow therapy: mechanisms of action. Respir Med. 2009; 103(10):1400-5. DOI: 10.1016/j.rmed.2009.04.007. View

Murdoch E, Kempley S . Randomized trial examining cerebral haemodynamics following artificial or animal surfactant. Acta Paediatr. 1998; 87(4):411-5. DOI: 10.1080/08035259850157002. View

Mallol J, Rattray S, Walker G, Cook D, Robertson C . Aerosol deposition in infants with cystic fibrosis. Pediatr Pulmonol. 1996; 21(5):276-81. DOI: 10.1002/(SICI)1099-0496(199605)21:5<276::AID-PPUL2>3.0.CO;2-L. View

Stevens T, Finer N, Carlo W, Szilagyi P, Phelps D, Walsh M . Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT). J Pediatr. 2014; 165(2):240-249.e4. PMC: 4111960. DOI: 10.1016/j.jpeds.2014.02.054. View

Dargaville P, Rimensberger P, Frerichs I . Regional tidal ventilation and compliance during a stepwise vital capacity manoeuvre. Intensive Care Med. 2010; 36(11):1953-61. DOI: 10.1007/s00134-010-1995-1. View

10.

Mercier C, Soll R . Clinical trials of natural surfactant extract in respiratory distress syndrome. Clin Perinatol. 1993; 20(4):711-35. View

11.

Sandri F, Plavka R, Ancora G, Simeoni U, Stranak Z, Martinelli S . Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics. 2010; 125(6):e1402-9. DOI: 10.1542/peds.2009-2131. View

12.

Tingay D, Wallace M, Bhatia R, Schmolzer G, Zahra V, Dolan M . Surfactant before the first inflation at birth improves spatial distribution of ventilation and reduces lung injury in preterm lambs. J Appl Physiol (1985). 2013; 116(3):251-8. DOI: 10.1152/japplphysiol.01142.2013. View

13.

Lewis J, Tabor B, Ikegami M, Jobe A, Joseph M, Absolom D . Lung function and surfactant distribution in saline-lavaged sheep given instilled vs. nebulized surfactant. J Appl Physiol (1985). 1993; 74(3):1256-64. DOI: 10.1152/jappl.1993.74.3.1256. View

14.

Frerichs I, Dargaville P, van Genderingen H, Morel D, Rimensberger P . Lung volume recruitment after surfactant administration modifies spatial distribution of ventilation. Am J Respir Crit Care Med. 2006; 174(7):772-9. DOI: 10.1164/rccm.200512-1942OC. View

15.

Henry M, Rebello C, Ikegami M, Jobe A, Langenback E, Davis J . Ultrasonic nebulized in comparison with instilled surfactant treatment of preterm lambs. Am J Respir Crit Care Med. 1996; 154(2 Pt 1):366-75. DOI: 10.1164/ajrccm.154.2.8756808. View

16.

Leonhardt S, Lachmann B . Electrical impedance tomography: the holy grail of ventilation and perfusion monitoring?. Intensive Care Med. 2012; 38(12):1917-29. DOI: 10.1007/s00134-012-2684-z. View

17.

Rey-Santano C, Mielgo V, Andres L, Ruiz-Del-Yerro E, Valls-i-Soler A, Murgia X . Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome. Pediatr Res. 2013; 73(5):639-46. DOI: 10.1038/pr.2013.24. View

18.

Berggren E, Liljedahl M, Winbladh B, Andreasson B, Curstedt T, Robertson B . Pilot study of nebulized surfactant therapy for neonatal respiratory distress syndrome. Acta Paediatr. 2000; 89(4):460-4. DOI: 10.1080/080352500750028195. View

19.

Finer N, Merritt T, Bernstein G, Job L, Mazela J, Segal R . An open label, pilot study of Aerosurf® combined with nCPAP to prevent RDS in preterm neonates. J Aerosol Med Pulm Drug Deliv. 2010; 23(5):303-9. DOI: 10.1089/jamp.2009.0758. View

20.

Miedema M, de Jongh F, Frerichs I, van Veenendaal M, van Kaam A . Changes in lung volume and ventilation during surfactant treatment in ventilated preterm infants. Am J Respir Crit Care Med. 2011; 184(1):100-5. DOI: 10.1164/rccm.201103-0375OC. View