To the editor: Surfactant aerosol treatment of respiratory distress syndrome in spontaneously breathing premature infants

Jorch, Gerhard; Hartl, Heike; Roth, Bernhard; Kribs, Angela; Gortner, Ludwig; Schaible, T; Hennecke, Karl H; Poets, Christian F.

doi:10.1002/(sici)1099-0496(199709)24:3<222::aid-ppul9>3.0.co;2-o

Cited by 98 publications

(92 citation statements)

References 10 publications

(9 reference statements)

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“…This is in line with previous experimental findings, showing that nebulization of synthetic surfactant using CPAP increased lung compliance in anaesthetized lambs receiving CPAP (20) and both lung compliance and oxygenation in lavaged rabbits (21), and a clinical study on nebulized surfactant which reported an improvement of the (A/a) O 2 gradient compared to control (16). We used a preterm sheep model, which included two major advantages: First, the similarity in anatomy and size allowed the use of equipment which is originally used in humans.…”

Section: Discussionsupporting

confidence: 92%

“…Until now, there have been four clinical studies on nebulized surfactant as rescue therapy (13)(14)(15)(16). These studies confirmed the safety and feasibility of the method.…”

mentioning

confidence: 82%

“…These studies confirmed the safety and feasibility of the method. However, only one showed an immediate positive effect on oxygen delivery to treated infants (16). In addition, a clinical study recently presented by Minocchieri on the Pediatric Academic Societies Meeting 2013 reported a reduced need for intubation in preterm infants with RDS receiving CPAP plus nebulized surfactant in the first hours of life.…”

mentioning

confidence: 99%

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Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

et al. 2015

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Section: Discussionsupporting

confidence: 92%

“…Until now, there have been four clinical studies on nebulized surfactant as rescue therapy (13)(14)(15)(16). These studies confirmed the safety and feasibility of the method.…”

mentioning

confidence: 82%

mentioning

confidence: 99%

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Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

et al. 2015

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“…Clinical studies with aerosolized surfactant have in general not had impressive results. A small pilot study by Jorch et al 169 reported that aerosolized bovactant improved the alveolar-arterial oxygen difference in older pre-term infants (28 -35 weeks gestation), but studies with other aerosolized surfactants in pre-term infants found no respiratory benefits, [170][171][172] despite the known efficacy of instilled exogenous surfactant in that patient population. In addition, a large controlled study by Anzueto et al, 64 in which they administered aerosolized colfosceril palmitate to adults with ALI/ARDS, was also negative, as discussed in more detail below.…”

Section: Animal Studies Of Surfactantmentioning

confidence: 99%

The Future of Exogenous Surfactant Therapy

Willson

Notter

2011

Respir Care

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Since the identification of surfactant deficiency as the putative cause of the infant respiratory distress syndrome (RDS) by Avery and Mead in 1959, our understanding of the role of pulmonary surfactant in respiratory physiology and the pathophysiology of acute lung injury (ALI) has advanced substantially. Surfactant replacement has become routine for the prevention and treatment of infant RDS and other causes of neonatal lung injury. The role of surfactant in lung injury beyond the neonatal period, however, has proven more complex. Relative surfactant deficiency, dysfunction, and inhibition all contribute to the disturbed physiology seen in ALI and acute respiratory distress syndrome (ARDS). Consequently, exogenous surfactant, while a plausible therapy, has proven to be less effective in ALI/ ARDS than in RDS, where simple deficiency is causative. This failure may relate to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution, or simply an inability of the drug to substantially impact the underlying pathophysiology of ALI/ARDS. Both animal and human studies suggest that direct types of ALI (eg, aspiration, pneumonia) may be more responsive to surfactant therapy than indirect lung injury (eg, sepsis, pancreatitis). Animal studies are needed, however, to further clarify aspects of drug composition, timing, delivery, and dosing before additional human trials are pursued, as the results of human trials to date have been inconsistent and largely disappointing. Further study and perhaps the development of more robust pharmaceutical surfactants offer promise that exogenous surfactant will find a place in our armamentarium of treatment of ALI/ARDS in the future. Key words: surfactant; infant respiratory distress syndrome; RDS; acute lung injury; ALI; acute respiratory distress syndrome; ARDS; neonatal. [Respir Care 2011;56(9):1369 -1386.

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“…An uncontrolled study of nebulized Alveofact in 20 preterm neonates (median gestational age of 31 weeks, birthweight of 1,680 g) reported immediate improvements in oxygenation (alveolar-arterial difference), P aCO 2 , and dyspnea, although the improvement in breathing frequency did not reach statistical significance. 27 The investigators used an Intersurgical RO252/ME jet nebulizer at a flow of 8 L/min and delivered the aerosol directly via a nasopharyngeal tube. Fourteen of 20 infants did not require intubation, and the only adverse effect attributed to the nebulized surfactant was increased viscous secretions requiring frequent suctioning.…”

Section: Aerosolized Surfactants Anti-inflammatory Drugs and Analgementioning

confidence: 99%

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

Willson

2015

Respir Care

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Drug delivery by aerosol may have several advantages over other modes, particularly if the lung is the target organ. Aerosol delivery may allow achievement of higher concentrations while minimizing systemic effects and offers convenience, rapid onset of action, and avoidance of the needles and sterile technique necessary with intravenous drug administration. Aerosol delivery may change the pharmacokinetics of many drugs, however, and an awareness of the caveats of aerosolized drug delivery is mandatory to ensure both safety and adequate drug delivery. This paper discusses the administration of surfactants, anti-inflammatory agents, and analgesics by the aerosol route.

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To the editor: Surfactant aerosol treatment of respiratory distress syndrome in spontaneously breathing premature infants

Cited by 98 publications

References 10 publications

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

The Future of Exogenous Surfactant Therapy

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

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