Surfactant nebulisation:  safety, efficiency and influence  on surface lowering properties and biochemical composition

Dijk, Peter H.; Heikamp, A; Piers, Da; Weller, E.; Oetomo, Sb

doi:10.1007/s001340050358

Cited by 23 publications

(9 citation statements)

References 29 publications

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“…Nebulized surfactant has been shown to be safer and less harmful compared with intratracheal liquid instillation. A study performed by Dijk et al (31) has shown that the partial pressure of oxygen in arterial blood increased quickly after instillation compared with a gradual increase during nebulization of Alveofact Ò over 120 minutes. However, there were also rapid decreases in the mean arterial blood pressure and cerebral blood flow after liquid instillation by 22% and 64%, respectively, whereas there was no change in the mean arterial blood pressure and only 31% gradual drop of cerebral blood flow after nebulization.…”

Section: Discussionmentioning

confidence: 99%

Deposition of Aerosolized Lucinactant in Nonhuman Primates

Gregory

Irshad

Chand

et al. 2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Background: Lucinactant for inhalation is an investigational noninvasive, aerosolized surfactant replacement therapy for treatment of preterm neonates with respiratory distress syndrome. Lucinactant for inhalation consists of lyophilized lucinactant and the Aerosurf Ò Delivery System (ADS). The objective of this study was to characterize the total and regional pulmonary deposition of lucinactant delivered by the ADS in nonhuman primates (NHPs). Methods: Lucinactant was radiolabeled by the addition of technetium-99m (99m Tc)-sulfur colloid. The radiolabeled aerosol was characterized and validated using a Mercer cascade impactor. An in vivo deposition study was performed in three cynomolgus macaques. Radiolabeled lucinactant was aerosolized using the ADS and delivered via nasal cannula under 5 cm H 2 O nasal continuous positive airway pressure (nCPAP) for 5-9 minutes. A two-dimensional planar image was acquired immediately after aerosol administration, followed by a three-dimensional single-photon emission computed tomography (SPECT) image and a second planar image. The images were analyzed to determine the pulmonary (lungs) and extrapulmonary (nose + mouth, trachea, stomach) distribution. The SPECT data were used to determine regional deposition. Results: The radiolabed lucinactant aerosol had a mass median aerodynamic diameter ¼ 2.91 lm, geometric standard deviation (GSD) ¼ 1.81, and an activity median aerodynamic diameter ¼ 2.92 lm, GSD ¼ 2.06. Aerosolized lucinactant was observed to deposit in the lungs (11.4%), nose + mouth (79.9%), trachea (7.3%), and stomach (1.4%). Analysis of the SPECT image demonstrated that the regional deposition within the lung was generally homogeneous. Aerosolized lucinactant was deposited in both the central (52.8%-1.2%) and peripheral (47.2%-1.2%) regions of the lungs. Conclusion: Aerosolized lucinactant, delivered using the ADS via constant flow nCPAP, is deposited in all regions of the lungs demonstrating that surfactant can be aerosolized and delivered noninvasively to NHPs.

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Section: Discussionmentioning

confidence: 99%

Deposition of Aerosolized Lucinactant in Nonhuman Primates

Gregory

Irshad

Chand

et al. 2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…16 Dijk et al studied 9 infants and reported efficacy rates of <10% with surfactant nebulization and noted that most aerosolized surfactant was expired and did not reach the lungs. 17 More recent RCTs have reported minimal benefits at best. 18,19 Berggren et al conducted an RCT involving 32 infants (16 treated with nebulized surfactant and 16 who did not receive surfactant) and reported no significant difference in the requirement of mechanical ventilation or the incidence of BPD ( P > .05).…”

Section: Discussionmentioning

confidence: 99%

“…23 Efficacy rates of <10% have been attributed to the large particle size of the surfactant and the small airways of preterm neonates. 16-18,20,21 …”

Section: Discussionmentioning

confidence: 99%

Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Lau

Chamberlain

Sun

2017

Global Pediatric Health

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Neonatal respiratory distress syndrome due to surfactant deficiency is associated with high morbidity and mortality in preterm infants, and the use of less invasive surfactant administration (LISA) has been increasingly studied. This meta-analysis found that LISA via thin catheter significantly reduced the need for mechanical ventilation within the first 72 hours (relative risk [RR] = 0.677; P = .021), duration of mechanical ventilation (difference in means [MD] = −39.302 hours; P < .001), duration of supplemental oxygen (MD = −68.874 hours; P < .001), and duration of nasal continuous positive airway pressure (nCPAP; MD = −28.423 hours; P = .010). A trend toward a reduction in the incidence of bronchopulmonary dysplasia was observed (RR = 0.656; P = .141). No significant difference in overall mortality, incidence of pneumothorax, or successful first attempts was observed. LISA via thin catheter significantly reduces the need for mechanical ventilation within the first 72 hours as well as the duration of mechanical ventilation, supplemental oxygen, and nCPAP. LISA via thin catheter appears promising in improving preterm infant outcomes.

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“…In the SURFNEB group, surfactant was nebulised using the Miniheart low-flow volume medication nebuliser (MiniNEB, Vortran Medical Technology, Sacramento, Calif., USA) tested earlier during in vitro experiments [17]. This nebuliser produces an aerosol with particle sizes that enhance a peripheral deposition of the surfactant in the lungs (mass median aerodynamic diameter was 3 mm and 70 % of the particles were between 1 and 5 mm in diameter) [17].…”

Section: Surfactant Treatmentsmentioning

confidence: 99%