Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial

Göpel, Wolfgang; Kribs, Angela; Ziegler, Andreas; Laux, Reinhard; Hoehn, Thomas; Wieg, Christian; Siegel, Jens; Avenarius, Stefan; Wense, A. von der; Vochem, Matthias; Groneck, Peter; Weller, Ursula; Möller, Jens; Härtel, Christoph; Haller, Sebastian; Roth, Bernhard; Herting, Egbert

doi:10.1016/s0140-6736(11)60986-0

Cited by 420 publications

(476 citation statements)

References 28 publications

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“…The techniques of LISA to spontaneous breathing infants were introduced into the clinical practice without experimental evaluation (8,9,11). To our knowledge, this is the first study to investigate oxygenation, gas exchange, pulmonary surfactant distribution, and lung compliance in preterm lambs that either exclusively received CPAP, received LISA or were intubated and mechanically ventilated with surfactant administration.…”

Section: Discussionmentioning

confidence: 99%

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Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

et al. 2014

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Background: A new technique was proposed to administer surfactant to spontaneous breathing preterm infants by placing a thin catheter through the vocal cords. This technique was not studied with respect to oxygenation, gas exchange, surfactant distribution, and lung mechanics. We tested the technique of less-invasive surfactant administration (LISA) in a spontaneous breathing preterm lamb model. Methods: Preterm lambs (n = 12) of 133-134 d gestational age were randomized to the following three groups: (i) continuous positive airway pressure (CPAP) only, (ii) CPAP + LISA, and (iii) intubation and mechanical ventilation with surfactant administration. Surfactant was labeled with samarium oxide. During the next 180 min, blood gas analyses were performed. Postmortem, lungs were removed and surfactant distribution was assessed, and pressure-volume curves were performed. results: Pao 2 in the LISA-treated lambs was significantly higher than in the lambs that exclusively received CPAP. Moreover, Pao 2 values were similar between the LISA-treated and the intubated lambs. Overall, surfactant deposition was less in the LISA lambs, with significantly less surfactant distributed to the right upper lobe. Lung compliance was better in the intubated lambs compared with the LISA-treated lambs, although this did not reach significance. conclusion: LISA improved oxygenation, similar to conventional surfactant application techniques, despite lower surfactant deposition and lung compliance.i n the past decades, preterm infants have been treated with surfactant bolus replacement therapy for respiratory distress syndrome, which usually requires intubation and mechanical ventilation. Surfactant treatment in ventilated infants leads to a relative reduction in bronchopulmonary dysplasia, pneumothorax, and mortality (1,2). Randomized trials indicated that early surfactant therapy compared to delayed rescue surfactant treatment resulted in better respiratory and neurologic outcomes in preterm infants (3).Early surfactant treatment has therefore been combined with intubation and mechanical ventilation. Intubation of the trachea may lead to laryngeal or tracheal injury and requires premedication, which can delay the time to extubation. In addition, mechanical ventilation can damage the vulnerable preterm lungs. It has been hypothesized that avoidance of mechanical ventilation might lead to less bronchopulmonary dysplasia (4,5), as infants that failed initial continuous positive airway pressure (CPAP) therapy and needed subsequent mechanical ventilation showed higher bronchopulmonary dysplasia rates (6).In order to avoid the negative effects of mechanical ventilation, a new technique was recently introduced to administer surfactant endotracheally to spontaneously breathing preterm infants by placing a small feeding or arterial catheter through the vocal cords (7,8). This technique proved to be feasible in clinical practice with first attempt success rate above 80% (8-10). This technique was referred to as minimally invasive surfactant therap...

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Section: Discussionmentioning

confidence: 99%

“…This technique was referred to as minimally invasive surfactant therapy (8) or less-invasive surfactant administration (LISA) (9). In a multicenter randomized controlled trial, LISA led to a reduction in the need for mechanical ventilation (11). Moreover, a single-center trial showed a reduction in bronchopulmonary dysplasia rates (10).…”

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Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

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“…Using exogenous surfactant in the early stage of ARDS could be associated with lower dosage, better distribution and better efficacy. When lungs are less injured, other ways of administration could also be used, such as simple instillation or aerosolization because some new experimental studies (38)(39)(40) have shown a good distribution of these less invasive tools especially when lungs have not yet deteriorated. Other investigations in exogenous surfactant treatment in ARDS examined the possibility of using different types of synthetic surfactant.…”

Section: Resultsmentioning

confidence: 99%

Exogenous Surfactant Treatment in Children with ARDS

2013

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“…Ahora bien, los hallazgos de estos estudios no deben arrojar dudas sobre el hecho de que está ampliamente comprobado que el surfactante juega un papel crucial en la resolución de la dificultad respiratoria. El estudio CURPAP (35), un ensayo clínico europeo multicéntrico con recién nacidos de 25 a 28 semanas de gestación, asignados aleatoriamente a dos esquemas de tratamiento (surfactante profiláctico y CPAP) según dos estratos de edad de gestación, encontró que la necesidad de respiración mecánica asistida en los primeros cinco días de vida extrauterina fue de 32,4 % en quienes recibieron el surfactante, frente a 33,0 % en quienes solo recibieron CPAP; que la necesidad de respiración mecánica asistida era inversamente proporcional al peso al nacer y mayor en niños que en niñas, y que la incidencia de neumotórax era mayor en el grupo tratado con surfactante profiláctico, comparado con el tratado con CPAP únicamente.…”

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Nasal CPAP vs. mechanical ventilation in 28-32 weeks preterm infants with early surfactant administration

et al. 2014

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Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial

Cited by 420 publications

References 28 publications

Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

Exogenous Surfactant Treatment in Children with ARDS

Nasal CPAP vs. mechanical ventilation in 28-32 weeks preterm infants with early surfactant administration

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