Lucinactant and poractant alfa were similar in terms of efficacy and safety when used for the prevention and treatment of RDS among preterm infants. The ability to enhance the performance of a synthetic surfactant with the addition of a peptide that mimics the action of SP-B, such as sinapultide, brings potential advantages to exogenous surfactant therapy.

Aerosurf can be safely administered via nCPAP in preterm infants at risk for RDS and may provide an alternative to surfactant administration via an ET tube. Further studies are required to evaluate this delivery approach.

Dilute Surfaxin lavage seems to be a safe and potentially effective therapy in the treatment of MAS. Data from this investigation support future prospective, controlled clinical trials of bronchoalveolar lavage with Surfaxin in neonates with MAS.

Preterm infants have asynchronous thoracoabdominal motion (TAM) secondary to a highly compliant chest wall and different lung mechanics compared to term infants. We compared TAM during continuous positive airway pressure (CPAP) administered through an endotracheal tube (ETT‐CPAP) or nasal prongs (nasal‐CPAP), and during synchronized intermittent mandatory ventilation administered by nasal prongs (nasal‐SIMV) in 14 preterm newborn infants. Asynchrony of TAM was quantified by measuring relative motion of chest wall and abdomen with strain gauges and calculating phase angles (θ). Phase angles were lower during nasal‐SIMV compared to nasal‐CPAP or ETT‐CPAP (P < 0.05), and lower during nasal‐CPAP compared to ETT‐CPAP (P < 0.05). The reduced TAM asynchrony during nasal‐SIMV and nasal‐CPAP may be due to elimination of resistance of the ETT and/or effective stabilization of the chest wall. These data suggest that nasal‐SIMV may be an effective mode of respiratory support for preterm infants requiring minimal ventilatory support. Pediatr. Pulmonol. 1998; 25:175–181. © 1998 Wiley‐Liss, Inc.

No abstract

Flow-triggered ventilators are susceptible to autocycling due to flow compensation to maintain positive end-expiratory pressure levels in the presence of an airway leak. The difference in autocycling is due to the maximum sensitivity setting of each ventilator, and not to intrinsic ventilator flowsensing or other software mechanisms. The 3.3-mL/sec setting was the least prone to autocycling and seems appropriate. The ventilator set at 2.5 mL/sec at the time of this study has been released instead at 4 mL/sec, due to these findings. The ventilator with the maximum setting at 1 mL/sec autocycled readily at leak size of > or = 10%. Since such a leak size was present in 70% of infants, this setting should be used with caution. Using these guidelines, autocycling of all three ventilators is likely to occur mainly in 8% of infants with leak size of > 30%. In these cases, lowering the sensitivity setting and/or positive end-expiratory pressure level may decrease autocycling, or may necessitate reintubation with a larger endotracheal tube.

No abstract

We compared expiratory tidal and minute ventilation during conventional and synchronized intermittent mandatory ventilation (IMV and SIMV) in 30 infants with respiratory failure. Identical ventilator settings were used during each mode in each infant. Tidal volumes of ventilator breaths were smaller during IMV than during SIMV (6.2 +/- 1.8 versus 7.4 +/- 1.9 ml/kg; p < 0.01). The coefficient of variation of tidal volumes was higher during IMV than SIMV for both ventilator (25 +/- 12% versus 15 +/- 8%) and spontaneous breaths (39 +/- 15% versus 24 +/- 10%, p < 0.001). Minute ventilation, however, was the same during both modes. During IMV, one infant breathed synchronously and two were phase-locked in asynchrony with the ventilator. The infants with a mixed interaction on IMV (27 of 30) had tidal volumes that depended on the phase of spontaneous breathing at the time of onset of each ventilator breath. Tidal volumes of IMV breaths that began during the first half of spontaneous expiration had the smallest tidal volumes (5.4 +/- 1.8 ml/kg, p < 0.01), followed by those that began during the last half of inspiration (6.4 +/- 1.8 ml/kg, p < 0.01). Thus, the synchrony produced by SIMV allowed the ventilator to deliver larger and more consistent tidal volumes than during IMV.