Non-Invasive Ventilation and Surfactant Therapy

Abstract

The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation. Published literature supporting the use of non-invasive respiratory support with CPAP, bi-level CPAP mode, such as, SiPAP and Nasal Intermittent Positive Pressure Ventilation (NIPPV), and surfactant administration strategies are discussed. This review focuses on non-invasive respiratory support strategies and selective early use of surfactant that may reduce the incidence of bronchopulmonary dysplasia. Invasive VentilationBronchopulmonary Dysplasia (BPD) remains major pulmonary morbidity in preterm infants with Respiratory Distress Syndrome (RDS), especially among the Extremely Low Birth Weight (ELBW) infants, [1] and is associated with short-and long-term adverse pulmonary and non-pulmonary outcomes. Advances in perinatal care, including antenatal corticosteroid use, advances in invasive mechanical ventilation modes, and postnatal surfactant therapy have significantly decreased the severity of RDS and neonatal mortality. Despite these changes, invasive ventilation via an endotracheal tube remains as one of the major reasons for the development of BPD. Prophylactic or rescue surfactant therapy alone has not been shown to decrease BPD rate. Noninvasive respiratory support modes, especially bilevel CPAP or SiPAP mode, have not been shown to impact BPD rate. However, use of early, rescue surfactant therapy and NIPPV mode has been shown to decrease BPD rate. This review will focus on the benefits of surfactant therapy used in combination with NIPPV mode of respiratory support in preterm infants.

Establishment of LC-MS methods for the analysis of palmitoylated surfactant proteins

“…1C ). Our results are in good agreement with the reported concentration of SP-B in Infasurf, which is 0.26 mg/ml ( 5 ).…”

“…It is known that Infasurf contains 0.7 mg/ml protein, in which the SP-B concentration was 0.23 mg/ml in this study ( Fig. 1C ) ( 5 ). The silver staining result ( Fig.…”

“…For comparison, we performed a similar analysis using another surfactant drug, Infasurf, in which SP-B concentration is already reported ( Fig. 1B ) ( 5 ). We quantifi ed SP-B in three vials each of Surfacten and Infasurf using standard curves of human SP-B, and obtained average concentrations of 0.053 mg/ml in Surfacten and 0.23 mg/ml in Infasurf ( Fig.…”

Heated Humified High Flow Nasal Cannulae (HHHFNC), in The Beginning it was the Flow!

“…In the same time another simplification was added to the non invasive ventilation by using a nasal cannula that was simpler and less traumatic than classical CPAP nasal interface, named RAM nasal cannula. It's a modification of the classical nasal catheter to accommodate the patient circuit which made nasal ventilation, NCPAP and lately HHHFNC application more comfortable and less traumatic [12]. The use of the Ram cannula added to the easiness of HHHFNC and then was used later with other modes of non invasive ventilation.…”