Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome

Rey-Santano, Carmen; Mielgo, Victoria; Andrés, Leire; Ruiz-del-Yerro, Estibaliz; Valls-i-Soler, Adolfo; Murgia, Xabier

doi:10.1038/pr.2013.24

Cited by 33 publications

(28 citation statements)

References 39 publications

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“…We found positive physiological effects of surfactant nebulization using binasal CPAP provided by prongs. In contrary, previous animal studies which showed positive effects of nebulized natural surfactant on lung function have mainly focused on tracheostomized, intubated, and ventilated sheep (17,23) or rabbits (18,24). Our data indicate that nebulized surfactant reached the lung and was deposited in all lung lobes.…”

Section: Discussioncontrasting

confidence: 80%

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

et al. 2015

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Section: Discussioncontrasting

confidence: 80%

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

et al. 2015

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“…Notwithstanding differences in nebulizer design, and thus particle size production, such modest deposition is likely due to the fact that most studies used aerosols generated extracorporeally by nebulizers connected to the ventilator circuit. This leads to high amounts of surfactant loss in the circuit, environment, and upper airway mucosa rather than the intended deep lung deposition.An alternative approach, using special catheters designed for intracorporeal surfactant nebulization has been proposed (8,21). Intratracheal nebulization of surfactant using this method has been shown to provide equivalent oxygen response as standard bolus therapy (8,21), with high and even surfactant deposition (21), improved histological score, and less cerebral hemodynamics fluctuations in adult rabbits (21) and preterm lambs (8) with severe induced RDS.…”

mentioning

confidence: 99%

“…An alternative approach, using special catheters designed for intracorporeal surfactant nebulization has been proposed (8,21). Intratracheal nebulization of surfactant using this method has been shown to provide equivalent oxygen response as standard bolus therapy (8,21), with high and even surfactant deposition (21), improved histological score, and less cerebral hemodynamics fluctuations in adult rabbits (21) and preterm lambs (8) with severe induced RDS.…”

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confidence: 99%

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Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

et al. 2016

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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 CBF conclusion: 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. s urfactant replacement therapy is a well-established standard of care for the treatment and prevention of neonatal respiratory distress syndrome (RDS), significantly reducing mortality and morbidity (1). Currently, endotracheal instillation is the only approved method of administration. However, over the last decade, the management of mild to moderate RDS has dramatically changed, endotracheal tube (ETT) intubation is often avoided and infants were managed with noninvasive modalities, such as continuous positive airway pressure whilst spontaneously breathing. In this population, surfactant administration is generally only provided when oxygen requirement increases and intubation is necessary (2,3).The increase in noninvasive ventilation use has led to less invasive methods of surfactant delivery during continuous positive airway pressure being developed (4,5). All reported methods require technical skills, some degree of invasive intervention, and still involve instillation of liquid surfactant directly into the trachea via a process that is not dissimilar to intubation (6-8). Nebulization of surfactant offers an attractive alternative. Unfortunately, studies of nebulized surfactant have shown inconsistent clinical response and surfactant distribution (9-16). Moreover, most of the studies, even those in which a lung function improvement was observed, reported very low (<10%) fractions of surfactant deposition into the lung (9,12,(17)(18)(19)(20). Notwithstanding differences in nebulizer design, and thus particle size production, such modest deposition is likely due to the fact that most studies used aerosols generated extracorporeally by ...

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“…24 Aerosolized and instilled Curosurf in preterm lambs demonstrated comparable improvement in gas exchange and compliance, but cerebral hemodynamic changes during administration were less severe with the aerosol route. 25 Wagner et al 26 compared nebulized and instilled Curosurf (200 mg/kg) in a similar rabbit lung lavage injury model. Their nebulizer delivered a fog with a droplet size of 120 Ϯ 4 m via an intratracheal catheter.…”

Section: Aerosolized Surfactants Anti-inflammatory Drugs and Analgementioning

confidence: 99%

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

Willson

2015

Respir Care

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Drug delivery by aerosol may have several advantages over other modes, particularly if the lung is the target organ. Aerosol delivery may allow achievement of higher concentrations while minimizing systemic effects and offers convenience, rapid onset of action, and avoidance of the needles and sterile technique necessary with intravenous drug administration. Aerosol delivery may change the pharmacokinetics of many drugs, however, and an awareness of the caveats of aerosolized drug delivery is mandatory to ensure both safety and adequate drug delivery. This paper discusses the administration of surfactants, anti-inflammatory agents, and analgesics by the aerosol route.

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Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome

Cited by 33 publications

References 39 publications

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

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