Early surfactant in spontaneously breathing with nCPAP in ELBW infants – a single centre four year experience

Kribs, Angela; Vierzig, Anne; Hünseler, Christoph; Eifinger, Frank; Welzing, Lars; Stützer, H.; Roth, Bernhard

doi:10.1111/j.1651-2227.2007.00617.x

Cited by 85 publications

(83 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These results, combined with subsequent experiences, were published this year. 9 The data confirmed the results of the original feasibility study. Our ongoing randomized controlled trials utilizing this technique are registered (AMV trial ISRCTN 05025922, NINSAPP trial ISRCTN 64011614), but the results are not yet available.…”

supporting

confidence: 78%

Potential confounder of NEC clinical trials

2009

View full text Add to dashboard Cite

With great interest we read the article 'Surfactants: past, present and future' by HL Halliday. 1 This article describes very well the unique success story of this wonderful substance that has not yet been finished. We were surprised to read about 'surfactant administration in spontaneously breathing infants using a fine gastric tube' as a single report at a meeting. In our German literature, this method has been more extensively reported. At our center, we developed and introduced this method for the first time. This method combines the positive effects of nCPAP and surfactant. The underlying idea is that inspiring surfactant is more physiologically appropriate than receiving it by positive pressure inflations as with the INSURE procedure. We reported the results in 2003 at the annual meeting of the GNPI (Gesellschaft fü r Neonatologie und Pädiatrische IntensivmedizinFSociety for Neonatology and Pediatric Intensive Care) in Cologne. 2 This method was a topic of discussion at the annual meetings of the GNPI in the following years too. 3-7 Therefore, we performed a pilot study in infants with a gestational age below 27 0=7 weeks. In this study, we showed the feasibility and an improvement of outcomes of the study group compared with a historical control group. 8 The need for mechanical ventilation because of RDS was reduced from 77% in the historical control group to 48% in the study group. Mortality decreased from 35 to 12% and the rate of severe IVH in survivors from 32 to 5%. These results, combined with subsequent experiences, were published this year. 9 The data confirmed the results of the original feasibility study. Our ongoing randomized controlled trials utilizing this technique are registered (AMV trial ISRCTN 05025922, NINSAPP trial ISRCTN 64011614), but the results are not yet available.

show abstract

supporting

confidence: 78%

Potential confounder of NEC clinical trials

2009

View full text Add to dashboard Cite

show abstract

“…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).…”

mentioning

confidence: 99%

“…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)(9)(10).…”

mentioning

confidence: 99%

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

et al. 2014

Self Cite

View full text Add to dashboard Cite

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...

show abstract

“…(2) In 2008 and 2009, German researchers described a previously unpublished method of surfactant administration via a thin endotracheal catheter introduced by laryngospcopy. (6) The first multicenter results of the study conducted in Germany using this method have recently been made available. Despite the sucess in the treatment of RDS, this method is limited by the difficulty of the technique and by not eliminating the pain and intense trauma related to laryngoscopy in active, non-asphyxiated newborns without sedation or analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…The use of nebulized surfactant still faces technical difficulties that prevent a final demonstration of its efficacy in vivo. In recent years, studies have been published describing the nasopharyngeal instillation of surfactant in the delivery room, (5) administration via a thin endotracheal catheter (6,7) or via a laryngeal mask airway (LMA). (2) The initial results in a small number of patients suggested LMA as a possible alternative route for surfactant treatment.…”

Section: Introductionmentioning

confidence: 99%

Máscara laríngea ProSealTM como via de administração de surfactante no tratamento da síndrome do desconforto respiratório em recém-nascido pré-termo

Barbosa¹,

Marcatto²,

Silva³

et al. 2012

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

Early surfactant in spontaneously breathing with nCPAP in ELBW infants – a single centre four year experience

Abstract: The success of nCPAP increased with increasing use of nCPAP with surfactant. Simultaneously, mortality decreased without deterioration of other outcomes indicating that the use of surfactant in spontaneous breathing with nCPAP could be beneficial.

Cited by 85 publications

References 22 publications

Potential confounder of NEC clinical trials

Potential confounder of NEC clinical trials

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

Máscara laríngea ProSealTM como via de administração de surfactante no tratamento da síndrome do desconforto respiratório em recém-nascido pré-termo

Contact Info

Product

Resources

About