Innovation in Surfactant Therapy II: Surfactant Administration by Aerosolization

Abstract

Instilled bolus surfactant is the only approved surfactant treatment for neonatal respiratory distress syndrome. However, recent trends towards increased utilization of noninvasive respiratory support for preterm infants with surfactant deficiency have created a demand for a similarly noninvasive means of administering exogenous surfactant. Past approaches to surfactant nebulization met with varying success due to inefficient aerosol devices resulting in low intrapulmonary delivery doses of surfactant with variable clinical effectiveness. The recent development of vibrating membrane nebulizers, coupled with appropriate positioning of the interface device, indicates that efficient delivery of aerosolized surfactant is now a realistic goal in infants. Evidence of clinical effect despite low total administered dose in pilot studies, together with suggestions of enhanced homogeneity of pulmonary distribution indicate that this therapy may be applied in a cost-effective manner, with minimal patient handling and disruption. These studies need to be subjected to appropriately designed randomized controlled trials. Further work is also required to determine the optimum delivery route (mask, intranasal prong, nasopharyngeal or laryngeal), dosing amount and redosing interval.

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

“…However, physiological differences between the acute lung injury model and our preterm RDS model have to be taken into account when comparing different surfactant preparations. In addition, different nebulization techniques showed differences in their suitability for surfactant nebulization (32), and different surface active substances affected nebulization depending on the nebulizer (33). The nebulizer we used has been reported to be suitable for nebulization of Poractant alfa, and surfactant characteristics were similar before and after nebulization (34).…”

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

“…(2) Aerosolization may produce more homogeneous surfactant distribution in the lung. 15 (3) Less of the drug may be needed (as little as 2-3 mg/kg as opposed to the usual instilled dose of 100 mg/kg). 16 (4) Aerosolization may allow surfactant to be administered without the need for an artificial airway.…”

Assessing New Technologies in Aerosol Medicine: Strengths and Limitations

“…69 Another version of the investigational device is also available for neonatal ventilators and has been evaluated for delivery of surfactant. 70 Trudell Medical International (London, Ontario, Canada) has developed a single-patient-use continuous nebulization system for mechanical ventilation (Solarys VADS) (see Fig. 6).…”