Exogenous surfactant: intubated present, nebulized future?

Shah, Shetal

doi:10.1007/s12519-010-0201-4

Cited by 21 publications

(14 citation statements)

References 37 publications

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“…Nebulized surfactant is potentially a therapeutic option to avoid the severe volutraumatic and barotraumatic effects of mechanical ventilation. However, several issues regarding cost-effectiveness, the development of nebulizer devices capable of its administration, and dosing strategies remain unresolved [103]. An open-label randomized controlled pilot study to evaluate the safety and efficacy of aerosolized porcine surfactant in the first hour of life in preterm infants with RDS (CureNeb) is ongoing in Australia.…”

Section: How Should Preterm Infants With Rds Be Treated With Exogenoumentioning

confidence: 99%

Exogenous surfactant therapy in 2013: what is next? who, when and how should we treat newborn infants in the future?

et al. 2013

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BackgroundSurfactant therapy is one of the few treatments that have dramatically changed clinical practice in neonatology. In addition to respiratory distress syndrome (RDS), surfactant deficiency is observed in many other clinical situations in term and preterm infants, raising several questions regarding the use of surfactant therapy.ObjectivesThis review focuses on several points of interest, including some controversial or confusing topics being faced by clinicians together with emerging or innovative concepts and techniques, according to the state of the art and the published literature as of 2013. Surfactant therapy has primarily focused on RDS in the preterm newborn. However, whether this treatment would be of benefit to a more heterogeneous population of infants with lung diseases other than RDS needs to be determined. Early trials have highlighted the benefits of prophylactic surfactant administration to newborns judged to be at risk of developing RDS. In preterm newborns that have undergone prenatal lung maturation with steroids and early treatment with continuous positive airway pressure (CPAP), the criteria for surfactant administration, including the optimal time and the severity of RDS, are still under discussion. Tracheal intubation is no longer systematically done for surfactant administration to newborns. Alternative modes of surfactant administration, including minimally-invasive and aerosolized delivery, could thus allow this treatment to be used in cases of RDS in unstable preterm newborns, in whom the tracheal intubation procedure still poses an ethical and medical challenge.ConclusionThe optimization of the uses and methods of surfactant administration will be one of the most important challenges in neonatal intensive care in the years to come.

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Section: How Should Preterm Infants With Rds Be Treated With Exogenoumentioning

confidence: 99%

Exogenous surfactant therapy in 2013: what is next? who, when and how should we treat newborn infants in the future?

et al. 2013

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“…Aerosol enters only ventilated lung units. 157,158,173 Aero-sol delivery to the alveoli in normal lungs is maximal in the particle-size range 0.5-2.0 m, and it is possible to generate a stable surfactant aerosol with that particle size range from aqueous or powdered surfactant. 135,174,175 A recent study by Ruppert et al 135 demonstrated the ability to deliver substantial amounts of a powder recombinant protein C surfactant aerosol with a new aerosol generator to improve oxygenation and compliance in lung-lavaged rabbits.…”

Section: Animal Studies Of Surfactantmentioning

confidence: 99%

The Future of Exogenous Surfactant Therapy

Willson

Notter

2011

Respir Care

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Since the identification of surfactant deficiency as the putative cause of the infant respiratory distress syndrome (RDS) by Avery and Mead in 1959, our understanding of the role of pulmonary surfactant in respiratory physiology and the pathophysiology of acute lung injury (ALI) has advanced substantially. Surfactant replacement has become routine for the prevention and treatment of infant RDS and other causes of neonatal lung injury. The role of surfactant in lung injury beyond the neonatal period, however, has proven more complex. Relative surfactant deficiency, dysfunction, and inhibition all contribute to the disturbed physiology seen in ALI and acute respiratory distress syndrome (ARDS). Consequently, exogenous surfactant, while a plausible therapy, has proven to be less effective in ALI/ ARDS than in RDS, where simple deficiency is causative. This failure may relate to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution, or simply an inability of the drug to substantially impact the underlying pathophysiology of ALI/ARDS. Both animal and human studies suggest that direct types of ALI (eg, aspiration, pneumonia) may be more responsive to surfactant therapy than indirect lung injury (eg, sepsis, pancreatitis). Animal studies are needed, however, to further clarify aspects of drug composition, timing, delivery, and dosing before additional human trials are pursued, as the results of human trials to date have been inconsistent and largely disappointing. Further study and perhaps the development of more robust pharmaceutical surfactants offer promise that exogenous surfactant will find a place in our armamentarium of treatment of ALI/ARDS in the future. Key words: surfactant; infant respiratory distress syndrome; RDS; acute lung injury; ALI; acute respiratory distress syndrome; ARDS; neonatal. [Respir Care 2011;56(9):1369 -1386.

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“…[21][22][23] Although the technique appears to be well tolerated, later-phase trials must be conducted to compare the benefits and harms of this technique with those of administration of intra-tracheal surfactant. 24 …”

Section: Ncpap For Rds In Preterm Infantsmentioning

confidence: 99%

Alternative therapies for respiratory distress syndrome in preterm infants

Sinha¹,

Sinha

2011

RRN

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Abstract:There is growing interest in the use of noninvasive methods of providing respiratory support to preterm infants, especially those born at the limits of viability. This paper relates to the use of noninvasive forms of respiratory support, which could be used to treat preterm infants with respiratory distress syndrome (RDS). Evidence is reviewed from clinical trials that have evaluated the use of continuous positive airway pressure (CPAP), nasal intermittent positive airway pressure (NIPPV), and high flow nasal cannulae (HFNC).

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Exogenous surfactant: intubated present, nebulized future?

Cited by 21 publications

References 37 publications

Exogenous surfactant therapy in 2013: what is next? who, when and how should we treat newborn infants in the future?

Exogenous surfactant therapy in 2013: what is next? who, when and how should we treat newborn infants in the future?

The Future of Exogenous Surfactant Therapy

Alternative therapies for respiratory distress syndrome in preterm infants

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