Nebulized Poractant Alfa Reduces the Risk of Respiratory Failure at 72 Hours in Spontaneously Breathing Surfactant-Deficient Newborn Piglets
[EN]In recent years, the way surfactant is administered in neonatal ICUs has changed considerably, from standard bolus therapy (intubation-mechanical ventilation) to the intubation surfactant extubation (InSurE) method, the less invasive surfactant administration method, or investigational approache...
| Autores: | , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2020 |
| País: | España |
| Institución: | Universidad del País Vasco |
| Repositorio: | Addi. Archivo Digital para la Docencia y la Investigación |
| OAI Identifier: | oai:addi.ehu.eus:10810/70940 |
| Acceso en línea: | http://hdl.handle.net/10810/70940 |
| Access Level: | acceso abierto |
| Palabra clave: | brain inflammation long-term study nebulized surfactant respiratory distress syndrome |
| Sumario: | [EN]In recent years, the way surfactant is administered in neonatal ICUs has changed considerably, from standard bolus therapy (intubation-mechanical ventilation) to the intubation surfactant extubation (InSurE) method, the less invasive surfactant administration method, or investigational approaches like surfactant nebulization (1–3). The use of nebulized surfactant seems to be the least invasive approach, fully avoiding the risks associated with instillation of a surfactant bolus into the trachea in neonates with respiratory distress syndrome (RDS). Although preclinical and clinical studies using nebulized surfactant have not been always successful (studies having differed in nebulizer type and surfactant dosage), overall, the treatment appears to be safe and well tolerated (3–14). A new device based on vibrating membrane technology (eFlow-Neos Nebulizer; Pari Pharma, Starnberg, Germany) has been designed for use in infants and is able to deliver high doses of surfactant, while surfactant characteristics remain unchanged after nebulization (15–17). Only one clinical trial has evaluated the efficacy of using this nebulizer (200 mg/kg; poractant-alfa) and found only less need for intubation in the first 3 days compared to that with nasal continuous positive airway pressure (nCPAP) treatment (3). Considering the known surfactant losses during nebulization, it is reasonable to also explore the efficacy of higher doses (18). The aim of this study was to assess, for the first time over the critical period of 72 hours after surfactant treatment, the efficacy and safety of poractant alfa 400 mg/kg nebulization (18), using the eFlow-Neos nebulizer (Pari Pharma), as a noninvasive method of administering surfactant for the treatment of neonatal RDS. We hypothesized that the combination of nCPAP and nebulized surfactant would reduce the nCPAP failure rate as measured by the need for intubation and mechanical ventilation in spontaneously breathing newborn piglets, with bronchoalveolar lavage (BAL)–induced RDS. Furthermore, we assessed the impact of nebulized surfactant on gas exchange, hemodynamic parameters, oxygen metabolism, and lung and brain injury scores. |
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