Surfactant Bolus Instillation: Effects of Different Doses on Blood Pressure and Cerebral Blood Flow Velocities

Reisslein, Martin; Segerer, Hugo; Kiessling, Christiane; Obladen, Michael

doi:10.1159/000244085

Cited by 25 publications

(13 citation statements)

References 17 publications

(22 reference statements)

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“…Some studies reported that not all preterm infants experienced impaired autoregulation or pressure-passive cerebral circulation. 9,10 However, it should be noted that these studies involved a small number of infants with a higher birth weight and gestational age than those in our study. Furthermore, surfactant treatment was given prophylactically, which may mean that some infants were included who would not have developed RDS.…”

Section: Discussionmentioning

confidence: 58%

“…Most of these studies demonstrated significant changes in blood pressure and CBFV within 5 minutes after surfactant administration and then returned to baseline levels within 20 to 30 minutes. [7][8][9][10][11] In human newborn infants, there are only two studies 12,13 using synthetic surfactant (colfoceril palmitate) (Exosurf; Glaxo Wellcome, Research Triange Park, NC), and these studies showed conflicting results with regard to CBFV changes. There is only one study using bovine natural surfactant that showed no significant changes in CBFV with surfactant administration.…”

Section: Discussionmentioning

confidence: 99%

“…This is indirect evidence indicating no significant change in cardiac output, because the cardiac function of preterm infants has a limited ventricular diastolic compliance, and cardiac output is heart rate-dependent. 17 The influence of dose-dependent porcine surfactant on systemic and cerebral hemodynamics has been demonstrated by a few studies in both animal and human newborn infants 10,16 by comparing a low dose (100 mg/kg) with a high dose (200 mg/kg). The higher the dose of surfactant, the greater the decrease in MBP and CBFV.…”

Section: Discussionmentioning

confidence: 99%

“…Both variables were included because they have been reported to have an effect on CBFV and blood pressure. 4 -6 Furthermore, an increase in PACO 2 has been reported with surfactant administration in various studies, [7][8][9][10][11][12][13] and associated changes in CBFV were explained by PACO 2 changes. 12 The software used for statistical analysis was the S-Plus statistics package (Mathsoft, Seattle, WA).…”

Section: Methodsmentioning

confidence: 99%

“…6 In an attempt to relate cerebral blood flow changes to surfactant administration, the influence of surfactant on cerebral blood flow velocity (CBFV) was studied by several investigators but with conflicting results. [7][8][9][10][11][12][13][14] Most studies involved a small number of patients and used different preparations of surfactant and different techniques of administration.…”

mentioning

confidence: 99%

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Cerebral Blood Flow Velocity Changes After Bovine Natural Surfactant Instillation

et al. 2000

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OBJECTIVE:To determine the effects of bovine natural surfactant (beractant) instillation on cerebral hemodynamics in preterm infants with respiratory distress syndrome (RDS). STUDY DESIGN:Preterm infants who required surfactant for RDS were enrolled. Cerebral blood flow velocity (CBFV) waveforms from the pericallosal artery were analyzed by pulsed Doppler ultrasonography with the anterior fontanel serving as an acoustic window. CBFV was measured before and at 5, 10, 20, and 30 minutes after the first dose of a bolus instillation of surfactant in four aliquots. Simultaneously with CBFV measurements, mean blood pressure (MBP), heart rate, and ventilator settings were recorded. pH, PACO 2 , and PAO 2 before and at 30 minutes after surfactant administration were also determined. RESULTS:The 30 enrolled preterm infants had a mean birth weight of 973 gm (513 to 1996 gm) and a mean gestational age of 27 weeks (23 to 33 weeks). Mean postnatal age at surfactant administration was 4.7 Ϯ 2.7 hours. There were no significant changes in pH and PACO 2 before and at 30 minutes after surfactant (before surfactant: mean pH of 7.29 Ϯ 0.07 and mean PACO 2 of 44.4 Ϯ 7.1 torr; after surfactant: mean pH of 7.31 Ϯ 0.07 and mean PACO 2 of 42.7 Ϯ 8.3 torr). PAO 2 increased significantly from a pre-surfactant mean of 83 torr to 130 torr at 30 minutes after surfactant (p Ͻ 0.05), with no significant changes in mean airway pressure. There were no significant changes in MBP, heart rate, mean CBFV, peak systolic flow velocity, and diastolic flow velocity before and after surfactant instillation regardless of gestational age. Individ--ual changes in mean CBFV were related to MBP changes (p Ͻ 0.001, linear mixed models with random effects).

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Cerebral Blood Flow Velocity Changes After Bovine Natural Surfactant Instillation

et al. 2000

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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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The impact of surfactant replacement therapy on cerebral and systemic circulation and lung function

et al. 1997

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Surfactant Bolus Instillation: Effects of Different Doses on Blood Pressure and Cerebral Blood Flow Velocities

Cited by 25 publications

References 17 publications

Cerebral Blood Flow Velocity Changes After Bovine Natural Surfactant Instillation

Cerebral Blood Flow Velocity Changes After Bovine Natural Surfactant Instillation

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

The impact of surfactant replacement therapy on cerebral and systemic circulation and lung function

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