Rapid Tracheal Infusion of Surfactant versus Bolus Instillation in Rabbits: Effects on Oxygenation, Blood Pressure and Surfactant Distribution

Segerer, Hugo; Scheid, Annette; Wagner, M.; Lekka, Marilena E.; Obladen, Michael

doi:10.1159/000244286

Cited by 20 publications

(11 citation statements)

References 14 publications

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“…Animal studies show that rapid boluses are necessary for optimal distribution of surfac- tant to the lungs and physiological effects [8] . To avoid intubation, attempts have been made to give surfactant by aerosolization, but the results did not show benefi cial effects [9] .…”

Section: Discussionmentioning

confidence: 99%

Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

et al. 2005

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Background: The laryngeal mask airway (LMA^TM, Laryngeal Mask Co. Ltd, Jersey, UK) is a supraglottic device used to administer positive pressure ventilation (PPV) in adults, pediatric and neonatal patients. Objectives: To avoid endotracheal intubation, we evaluated the feasibility and practicality of administering surfactant via the LMA^TM in preterm infants with respiratory distress syndrome (RDS). Methods: Infants less than 72 h old with a gestational age of ≤35 weeks and a birth weight of >800 g, treated with nasal continuous positive airway pressure (CPAP, 5 cm H₂O) for RDS were eligible for inclusion in the study if the arterial-to-alveolar oxygen tension ratio (a/APO₂) was <0.20 over a period of >60 min. Results: Eight preterm infants, median gestational age 31 (range 28–35) weeks; birth weight 1,700 (880–2,520) g, treated with nasal CPAP for RDS were enrolled. Three hours after surfactant instillation, the mean a/APO₂ was significantly increased (0.13 ± 0.04 to 0.34 ± 0.11; p < 0.01) without complications. Conclusions: The LMA^TM may be a useful and noninvasive conduit for the administration of surfactant therapy. A large randomized comparative clinical trial will be required to confirm the efficacy of this technique.

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Section: Discussionmentioning

confidence: 99%

Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

et al. 2005

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“…Further there is a possibility that some of the surfactant components, lipids or proteins, induces a vasodilatation, either directly or by release of vasoactive substances. Moya et al demonstrated occurrence of platelet activating factor in Curosurf (21), but this finding was only partially confirmed by others, and was shown not to influence the haemodynamic response (22). A vasoactive agent should bind to endothelial receptors activating nitric oxide synthase (6).…”

Section: Discussionmentioning

confidence: 98%

Acute effects on systemic circulation after intratracheal instillation of Curosurf or Survanta in surfactant‐depleted newborn piglets

Møen

Almaas

et al. 1998

Acta Paediatrica

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Systemic vasodilatation in surfactant‐depleted newborn piglets is induced by 200 mg/kg of modified porcine lung surfactant (Curosurf™). The aim of this investigation was to study whether this effect is dependent on dose and could further be induced by instillation of a bovine surfactant preparation (Survanta™). Twenty‐two 3–5‐d old piglets were subjected to repeated saline lung lavage and then randomized to one of three groups. Instillation of either Curosurf 100 mg/kg (n= 8), Survanta 100 mg/kg (n= 7) or Curosurf 200 mg/kg (n= 7) was performed through the endotracheal tube. Systemic vascular resistance decreased 7 (± 4)%, 15 (± 12)% and 18 (± 6)% in the three groups, respectively (p < 0:05 in all three groups). A significant difference between the high and low dose Curosurf groups was found (p < 0:05), whereas no significant difference was seen between the Curosurf 100 mg group and the Survanta group. The decrease in vascular resistance was compensated by an increase in cardiac output, resulting in a stable mean arterial blood pressure. In conclusion, both Curosurf and Survanta induce a significant decrease in systemic vascular resistance in surfactant‐depleted newborn piglets. A more pronounced effect was observed after 200 mg/kg than after 100 mg/kg of Curosurf.

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“…Lung function data were not provided in that study. The same authors 34 compared bolus application vs. surfactant infusion over 5 min in the same rabbit model. Again, surfactant distribution in the lung was much less homogeneous in the animals belonging to the infusion group.…”

Section: Discussionmentioning

confidence: 99%

Rate of surfactant administration influences lung function and gas exchange in a surfactant-deficient rabbit model

1998

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The aim of this study was to test whether the effect of surfactant treatment on lung function in a surfactant‐deficient animal model can be influenced by the rate at which surfactant is administered. Surfactant deficiency was induced in 18 New Zealand white rabbits (weighing approx. 1 kg each) by lung lavage with normal saline. The arterial/alveolar oxygen ratio (a/A ratio), functional residual capacity (FRC), dynamic compliance of the respiratory system (Crs), tidal volume (VT), alveolar portion of the tidal volume (VA) and arterial PCO2 (Pa,CO2) were measured before and after lavage and 15, 30, 60, 90, and 120 min after administration of a single dose of surfactant (Survanta®, 100 mg/kg). Two surfactant administration protocols were compared over a 2‐h interval: an infusion lasting 4 min and an infusion over 2 min. Both administrations were given during continuous mechanical ventilation. The six lung function and gas exchange parameters improved significantly following surfactant administration over 2 min compared with a control group. However, only the a/A ratio and VA improved following the 4‐min protocol. Comparison of the two intervention protocols yielded significantly differences in VA and Pa,CO2, favoring the shorter administration. These results support the hypothesis that fast (2 min) administration of surfactant will improve its distribution to formerly collapsed alveoli and results in better lung function, improved ventilation, and (to a lesser extent) better oxygenation than prolonged infusions (4 min). Pediatr. Pulmonol. 1998; 25:196–204. © 1998 Wiley‐Liss, Inc.

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Rapid Tracheal Infusion of Surfactant versus Bolus Instillation in Rabbits: Effects on Oxygenation, Blood Pressure and Surfactant Distribution

Cited by 20 publications

References 14 publications

Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

Acute effects on systemic circulation after intratracheal instillation of Curosurf or Survanta in surfactant‐depleted newborn piglets

Rate of surfactant administration influences lung function and gas exchange in a surfactant-deficient rabbit model

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