Early surfactant therapy and noninvasive ventilation

Ramanathan, Rangasamy

doi:10.1038/sj.jp.7211717

Cited by 11 publications

(4 citation statements)

References 33 publications

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“…Саме тому неінвазивна вентиляція (НВ) була запропонована як метод дихальної підтримки, який дозволяє одночасно підтримати вентиляцію й уникнути інвазивних втручань. У кількох дослідженнях було виявлено переваги несинхронізованої назальної вентиляції порівняно із CPAP у зменшенні кількості випадків невдалої екстубації і зниженні ризику БЛД [11,15,16]. Цей метод забезпечує ШВЛ без ендотрахеальної трубки за допомогою назального пристрою (канюль, маски або назофарингеальной трубки).…”

Section: вступunclassified

Respiratory Support of Preterm Infants After Extubation: Comparison of Clinical Efficacy of Standart and High Frequency Non-Invasive Ventilation

Menshykova¹,

Dobryanskyy²

2015

Neonatol. hìr. perinat. med.

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Section: вступunclassified

Respiratory Support of Preterm Infants After Extubation: Comparison of Clinical Efficacy of Standart and High Frequency Non-Invasive Ventilation

Menshykova¹,

Dobryanskyy²

2015

Neonatol. hìr. perinat. med.

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“…Surfactant needs to reach the distal airways to be effective which meant intubation was needed for its administration with consequent mechanical ventilation for a variable period [6]. INSURE (INtubate, SURfactant , Extubate) strategy was evolved in Scandinavian countries that minimized the duration of ventilation post intubation and surfactant administration to four to six minutes and continuation of baby on noninvasive support and this significantly reduced the need for mechanical ventilation [7][8][9]. Further evolution of this towards avoiding the airway injury led to the introduction of MIST (minimally invasive surfactant therapy) and this has been widely assimilated in clinical practice by European neonatologists [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Surfactant Therapy: An Analytical Report of Our Prospective Dubai Cohort

Karthikeyan¹

2020

Cureus

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Introduction: Type 2 pneumocytes of the respiratory epithelium secrete the endogenous surfactant, a detergent-like substance that lines the alveolar sacs of the lungs. The surfactant facilitates the gas exchange process across the alveolar membrane by preventing the collapse of the alveoli and thereby maintaining their distended state. Respiratory distress syndrome of the premature neonates is characterized by quantitative and/or qualitative defects of endogenous surfactant metabolic pathways. The advent of exogenous surfactant therapy is rightly hailed as the major milestone in advancement of the care of the babies with surfactant-deficient lung disease. The administration of exogenous surfactant traditionally involves endotracheal intubation and mechanical ventilation. Minimally invasive surfactant therapy (MIST) is the technique of delivering surfactant without intubation whilst continuing the baby on noninvasive respiratory support. This author introduced MIST as the default way of administering surfactant in his neonatal units in Dubai and has to his credit the first published report on MIST from the United Arab Emirates in this journal in 2018. Objective: To analyze prospectively all our babies in Dubai who received surfactant by MIST. Design: Prospective descriptive study of all babies receiving surfactant by MIST starting from January 2018. Setting: Three tertiary care neonatal centers in Dubai. Patients and methods: Thirteen babies (gestation 27-36 weeks and birth weight 0.95-2.81 kg) were treated with MIST on 15 occasions. Catheterization techniques were by infant feeding tube in 10 babies, LISA (less invasive surfactant administration) catheter in one baby, and 2.0 size endotracheal tube (ETT) with surfactant filled syringe directly attached to its hub two times each in two babies. Curosurf the porcine surfactant at 200 mg/kg was used on nine occasions and Survanta the bovine surfactant at 4 mL/kg on six occasions. Main outcome measures: MIST success defined as the baby not needing intubation and ventilation within 72 hours post MIST. Outcome measures with respect to the different modalities of MIST procedure and surfactant preparations used in this prospective cohort. Results: Only one of the 13 babies (7.7%) in this cohort needed escalation of support with mechanical ventilation and high frequency oscillation (HFO). MIST using semi-rigid catheters like the LISA catheter or the smallest size ETT was technically easier to perform. No differences were observed with regard to the surfactant preparation used. None had an abnormal neurosonogram and there were no instances of sepsis and necrotizing enterocolitis either. The baby that had an unsuccessful MIST had retinopathy of prematurity that was effectively treated 1

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“…Respiratory distress syndrome (RDS) is defined as acute respiratory distress caused by surfactant deficiency that disturbs gas exchange in preterm infants. It is one of the most common neonatal problems and has been considered to be the most common cause of mortality and morbidity in preterm babies (1–4).…”

Section: Introductionmentioning

confidence: 99%

Criteria for Using INSURE in Management of Premature Babies with Respiratory Distress Syndrome

et al. 2019

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Introduction:Respiratory distress syndrome (RDS) is defined as acute respiratory distress caused by surfactant deficiency that disturbs gas exchange in preterm infants. It is one of the most common neonatal problems and has been considered to be the most common cause of mortality and morbidity in preterm babies.Aim:In this study, different variables were studied to predict factors for INSURE failure that might help in choosing infants for this procedure early.Methods:Sixty three (63) patients were enrolled in this study as they met the inclusion criteria. All neonates were intubated briefly less than 2 hours, given natural surfactant in the dose of 3 ml/kg. As soon as it was appropriate and the neonate was stable in the form of normal heart rate and oxygenation, extubation was done and the baby connected to NCPAP at a pressure of 6 cmH2O. INSURE failure was considered if the patient needed mechanical ventilation for more than 72 hours while INSURE success was considered if we were able to wean the patient from CPAP or if the patient didn’t need mechanical ventilation in the first 72 hours after surfactant administration. The indications for mechanical ventilation after INSURE procedure were respiratory distress with desaturation (02 sat less than 90%), recurrent apnea, Pco2 more than 60 mmHg.Results:Since INSURE procedure is being largely applied in the neonatal intensive care units, it is important to determine the candidate neonate for this procedure with the minimum failure rate. Although the sample of our study is small, but we can suggest that neonate with gestational age less than 28, birth weight less than 1000 gm, umbilical PH of less than 7, low Apgar score and anemic patients are at high risk for INSURE failure.Conclusion:Early diagnosis of PDA and IVH is essential to avoid INSURE method in these patients.

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Early surfactant therapy and noninvasive ventilation

Cited by 11 publications

References 33 publications

Respiratory Support of Preterm Infants After Extubation: Comparison of Clinical Efficacy of Standart and High Frequency Non-Invasive Ventilation

Respiratory Support of Preterm Infants After Extubation: Comparison of Clinical Efficacy of Standart and High Frequency Non-Invasive Ventilation

Minimally Invasive Surfactant Therapy: An Analytical Report of Our Prospective Dubai Cohort

Criteria for Using INSURE in Management of Premature Babies with Respiratory Distress Syndrome

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