Implementation of surfactant treatment during continuous positive airway pressure

Bohlin, Kajsa; Gudmundsdottir, Thorunn; Katz‐Salamon, Miriam; Jónsson, Baldvin; Blennow, Mats

doi:10.1038/sj.jp.7211754

Cited by 102 publications

(79 citation statements)

References 28 publications

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Section: Early Surfactant and Early Non-invasive Respiratory Supportmentioning

confidence: 90%

“…This method consists in intubation to instill exogenous surfactant and after that, extubation and connecting the patient to a non-invasive respiratory support. A reduction in mechanical ventilation needs has been shown in previous studies [11,12]. Some disadvantages about the INSURE method can be stated as follows: we are not completely avoiding intubation or mechanical ventilation, although they are used for a shorter time than in the classical method.…”

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confidence: 99%

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Minimally Invasive Surfactant Therapy: New Age

Candela¹

2015

J Neonatal Biol

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The BeginningDr. Von Neergaard first detected the surface tension in the gasliquid interphase and its role in the lung compliance in 1929, showing that more pressure was required to inflate lungs with air than with aqueous solution like water and concluding that retractile force of the lung was dependent on the surface tension in the alveoli [1]. To date, great advances in this field have been done. In 1959, Dr. Avery stablished the causal relationship between the hyaline membrane diseases in the premature infant with the absence of a substance that decreased the surface tension and so, increased the lung volume [2].After these discoveries, research study was headed for finding a way to create that foamy mix of proteins and fats called surfactant, but it was not until twenty years later, in 1980, when Dr. Fujiwara published the first clinical experience with exogenous surfactant, showing an improvement in oxygenation [3]. Ten years later the FDA approved the clinical use of this substance and contributed to the stunning advances in the prognosis of the premature infants with RDS, reducing air leak, oxygenation and neonatal death [4]. Nowadays trend about the management of neonatal RDS in the premature infant can be summarized in one main idea: the softer the management is, the better. With this concept in mind a new goal comes into view: avoiding intubation. This is the reason why the non-invasive respiratory support tries to become a substitute to intubation and mechanical ventilation when it is possible. This modality has shown a reduction in intubation, surfactant administration and non-significant reduction of death or bronchopulmonary dysplasia [RR 0.80 (CI 95% 0.58-1.12)] [8]. When comparing intubation and surfactant administration to non-invasive respiratory support, the latest is a valid alternative [9]. Type and DoseOn the other hand, newborns managed with non-invasive respiratory support, may need intubation and surfactant administration in a later phase of their evolution, and consequently, they cannot take advantage from the early surfactant therapy. This failure has been studied and estimated in 22% in the premature infants managed initially with this non-invasive support [10]. Early Surfactant and Early Non-Invasive Respiratory SupportBoth early surfactant and non-invasive respiratory support have shown benefits, so the next question should be which one is the best option. In this new age of softer management of preterm infants the question should turned into: why not using both?The option of giving surfactant reducing mechanical ventilation as much as possible is the INSURE technique (INtubate-SURfactantExtubate). This method consists in intubation to instill exogenous surfactant and after that, extubation and connecting the patient to a non-invasive respiratory support. A reduction in mechanical ventilation needs has been shown in previous studies [11,12]. Some disadvantages about the INSURE method can be stated as follows: we are not completely avoiding intubation or mechanical ventilation, alth...

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Section: Early Surfactant and Early Non-invasive Respiratory Supportmentioning

confidence: 90%

mentioning

confidence: 99%

Minimally Invasive Surfactant Therapy: New Age

Candela¹

2015

J Neonatal Biol

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“…The first of such methods of fast and non-invasive surfactant application was INtubateSURfactant-Extubate (INSURE). The extubation was followed by non-invasive respiratory support [37,38]. In comparing early INSURE method with CPAP without the administration of the surfactant, certain advantages were found in the INSURE group.…”

Section: Surfactantmentioning

confidence: 99%

Respiratory Care of the Neonate

Grosek¹,

Fister²

2018

Selected Topics in Neonatal Care

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The respiratory distress is a very common condition both in term and in preterm neonates and the most frequent reason for admission to the neonatal intensive care unit (NICU). The aetiology greatly depends on the maturation of neonate's organs and perinatal events. The clinical picture is sometimes scarce and very nonspecific for the etiologic determination. Treatment of neonatal RD begins first with the application of a mixture of oxygen and air, then with different modes of non-invasive respiratory support methods. Non-invasive respiratory support can be sustained with nasal continuous positive airway pressure, bi-level positive airway pressure and high-flow nasal cannula ventilation. Non-invasive ventilation with high-frequency oscillations through nasal cannula or masks is also possible with some respiratory devices. Non-invasive ventilation is usually combined with the application of natural surfactant and other therapeutic means, like methylxanthine therapy, prevention and closure of patent ductus arteriosus, and control of infection. In the case of non-invasive ventilation failure, different kinds of invasive ventilation methods are available and being practiced in NICUs. The invasive respiratory support can be maintained by controlled or intermittent mandatory ventilation combined with different supportive synchronous positive inspiratory ventilation, offered by modern respirators.

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“…Combining early CPAP with early surfactant administration seemed logical and a study reporting the use of surfactant administration in spontaneously breathing preterm infants [17] was followed by a randomized controlled study [18]. The strategy was named INtubation-SURfactant-Extubation (on nasal CPAP) -INSURE - [19] based on the synergistic effect on functional residual capacity. CPAP was shown to distends alveoli, maintain the patency of the airways during expiration, prevent surfactant depletion and the prevention of alveolar collapse.…”

Section: Introductionmentioning

confidence: 99%

Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

Ognean

Stoicescu

Boantă

et al. 2016

The Journal of Critical Care Medicine

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Introduction: Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability.

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Implementation of surfactant treatment during continuous positive airway pressure

Cited by 102 publications

References 28 publications

Minimally Invasive Surfactant Therapy: New Age

Minimally Invasive Surfactant Therapy: New Age

Respiratory Care of the Neonate

Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

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