Effects of bovine lipid extract surfactant administration in preterm infants treated for respiratory distress syndrome

Stockley, Elizabeth; Valotaire, Ronald; Miller, Michael R.; Silva, Orlando da

doi:10.1002/hsr2.34

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Building on these studies we used a modified natural surfactant, exposed the samples to EC generated aerosols, and focused on the main function of surfactant by measuring surface tension reduction. Specifically, we used BLES, a well-established commonly prescribed exogenous surfactant composed of the surfactant lipids and the hydrophobic proteins B and C [ 31 ]. Aerosol exposure was performed in a syringe containing a surfactant suspension allowing direct exposure of surfactant to the aerosol.…”

Section: Discussionmentioning

confidence: 99%

E-cigarette aerosol exposure of pulmonary surfactant impairs its surface tension reducing function

et al. 2022

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Introduction E-cigarette (EC) and vaping use continue to remain popular amongst teenage and young adult populations, despite several reports of vaping associated lung injury. One of the first compounds that EC aerosols comes into contact within the lungs during a deep inhalation is pulmonary surfactant. Impairment of surfactant’s critical surface tension reducing activity can contribute to lung dysfunction. Currently, information on how EC aerosols impacts pulmonary surfactant remains limited. We hypothesized that exposure to EC aerosol impairs the surface tension reducing ability of surfactant. Methods Bovine Lipid Extract Surfactant (BLES) was used as a model surfactant in a direct exposure syringe system. BLES (2ml) was placed in a syringe (30ml) attached to an EC. The generated aerosol was drawn into the syringe and then expelled, repeated 30 times. Biophysical analysis after exposure was completed using a constrained drop surfactometer (CDS). Results Minimum surface tensions increased significantly after exposure to the EC aerosol across 20 compression/expansion cycles. Mixing of non-aerosolized e-liquid did not result in significant changes. Variation in device used, addition of nicotine, or temperature of the aerosol had no additional effect. Two e-liquid flavours, menthol and red wedding, had further detrimental effects, resulting in significantly higher surface tension than the vehicle exposed BLES. Menthol exposed BLES has the highest minimum surface tensions across all 20 compression/expansion cycles. Alteration of surfactant properties through interaction with the produced aerosol was observed with a basic e-liquid vehicle, however additional compounds produced by added flavourings appeared to be able to increase inhibition. Conclusion EC aerosols alter surfactant function through increases in minimum surface tension. This impairment may contribute to lung dysfunction and susceptibility to further injury.

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Section: Discussionmentioning

confidence: 99%

E-cigarette aerosol exposure of pulmonary surfactant impairs its surface tension reducing function

et al. 2022

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“…Altogether, these trials enrolled 692 infants and some type of ETT obstruction was reported in between 6 and 11% of infants treated with BLES® [19]. A retrospective single center study done in Canada investigated the time to reach room air following BLES® administration in infants <37 weeks and no side effects were identified [21]. In the only prospective study, we described an incidence of 15% of SAO, mostly in extremely low birthweight infants (83%), an incidence similar to the Canadian RCT [19].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the bovine lipid extract surfactant being a low-cost preparation used for several years, only six clinical studies were performed: four randomized controlled trials (RCT) [ 9 , 18 – 20 ], one prospective observational study [ 10 ] and one retrospective single center analysis [ 21 ]. Unfortunately, except for one study [ 10 ], details on the surfactant administration technique is not provided and reports on major adverse effects were quite variable.…”

Section: Discussionmentioning

confidence: 99%

“Optimal surfactant delivery protocol using the bovine lipid extract surfactant: a quality improvement study”

et al. 2020

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Importance Episodes of severe airway obstruction (SAO) are reported during surfactant administration. Objective To evaluate adherence to and impact of a surfactant protocol on adverse events. Methods An evidence-based protocol for surfactant administration was developed (2011), implemented (2012) and reimplemented (2014), including three major steps: lung recruitment, manual bagging, and bolus instillation. Three epochs were evaluated: E 0 (2010), E 1 (2015) and E 2 (2018). Adherence was defined as compliance with all steps. Adverse events such as hypoxia (<80%) and severe airway obstruction (SAO) were investigated. Results 197 infants (246 administrations) were included: E 0 81 (110), E 1 52 (63), and E 2 64 (73). Adherence improved from 49% (E 1) to 67% (E 2). Full adherence to protocol significantly decreased SAO from 26% to 1.25% (E 2 ; p < 0.005) and hypoxia/bradycardia events (5 to 0% E 2 ; p < 0.005), without any side effects. Conclusions Adherence to a surfactant administration protocol improved over time and significantly decreased important adverse events.

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E-cigarette aerosol exposure of pulmonary surfactant impairs its surface tension reducing function

Graham

McCaig

Lau

et al. 2022

Preprint

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E-cigarette (EC) and vaping use continue to remain popular amongst teenage and young adult populations, despite several reports of vaping associated lung injury. This popularity is due in part to the vast variety of appealing flavours and nicotine concentrations easily accessible on the market. One of the first compounds that EC vapour comes into contact within the lungs during a deep inhalation is pulmonary surfactant. This lipid protein mixture lines the alveoli, reducing surface tension and preventing alveolar collapse. Impairment of surfactant’s critical surface tension reducing activity can contribute to lung dysfunction. Currently, information on how EC vapour impacts pulmonary surfactant remains limited. We hypothesized that exposure to EC vapour impairs the surface tension reducing ability of surfactant. BLES was used as a model surfactant in a direct exposure syringe system. BLES (2ml) was placed in a syringe (30ml) attached to an EC. Vapour was drawn into the syringe and then expelled, repeated 30 times. Biophysical analysis after exposure was completed using a constrained drop surfactometer (CDS). Minimum surface tensions increased after exposure to vapour. Variation in device used, addition of nicotine, or temperature of the vapour had no additional effect. Two e-liquid flavours, menthol and red wedding, had further detrimental effects, resulting in higher surface tension than the vehicle exposed BLES. Alteration of surfactant properties through interaction with vapour was observed with a basic e-liquid vehicle, however additional compounds produced by added flavourings appeared to be able to increase inhibition, however the exact mechanism remains unclear. In conclusion, EC vapour alters surfactant function through increases in minimum surface tension. This impairment can contribute to lung dysfunction and susceptibility to further injury.

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Effects of bovine lipid extract surfactant administration in preterm infants treated for respiratory distress syndrome

Cited by 4 publications

References 21 publications

E-cigarette aerosol exposure of pulmonary surfactant impairs its surface tension reducing function

E-cigarette aerosol exposure of pulmonary surfactant impairs its surface tension reducing function

“Optimal surfactant delivery protocol using the bovine lipid extract surfactant: a quality improvement study”

E-cigarette aerosol exposure of pulmonary surfactant impairs its surface tension reducing function

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