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Lung deposition of nebulized surfactant in newborn piglets : Nasal CPAP vs Nasal IPPV

Nord, Anders LU ; Linner, Rikard LU ; Salomone, Fabrizio ; Bianco, Federico ; Ricci, Francesca ; Murgia, Xabi ; Schlun, Martin ; Cunha-Goncalves, Doris LU and Perez-de-Sa, Valeria LU (2020) In Pediatric Pulmonology 55(2). p.514-520
Abstract

Background: Nasal continuous positive airway pressure support (nCPAP) is the standard of care for prematurely born infants at risk of neonatal respiratory distress syndrome (nRDS). However, nasal intermittent positive pressure ventilation (NIPPV) may be an alternative to nCPAP in babies requiring surfactant, and in conjunction with surfactant nebulization, it could theoretically reduce the need for invasive mechanical ventilation. We compared lung deposition of nebulized poractant in newborn piglets supported by nCPAP or NIPPV. Methods: Twenty-five sedated newborn piglets (1.2-2.2 kg) received either nCPAP (3 cmH2O, n = 12) or NIPPV (3 cmH2O positive end expiratory pressure+3 cmH2O inspiratory pressure,... (More)

Background: Nasal continuous positive airway pressure support (nCPAP) is the standard of care for prematurely born infants at risk of neonatal respiratory distress syndrome (nRDS). However, nasal intermittent positive pressure ventilation (NIPPV) may be an alternative to nCPAP in babies requiring surfactant, and in conjunction with surfactant nebulization, it could theoretically reduce the need for invasive mechanical ventilation. We compared lung deposition of nebulized poractant in newborn piglets supported by nCPAP or NIPPV. Methods: Twenty-five sedated newborn piglets (1.2-2.2 kg) received either nCPAP (3 cmH2O, n = 12) or NIPPV (3 cmH2O positive end expiratory pressure+3 cmH2O inspiratory pressure, n = 13) via custom-made nasal prongs (FiO2 0.4, Servo-i ventilator). Piglets received 200 mg kg−1 of technetium-99m-surfactant mixture continuously nebulized with a customized eFlow-Neos investigational vibrating-membrane nebulizer system. Blood gases were taken immediately before, during, and after nebulization. The deposition was estimated by gamma scintigraphy. Results: Mean surfactant deposition in the lungs was 15.9 ± 11.9% [8.3, 23.5] (mean ± SD [95% CI]) in the nCPAP group and 21.6 ± 10% [15.6, 27.6] in the NIPPV group (P =.20). Respiratory rates were similar in both groups. Minute volume was 489 ± 203 [360, 617] in the nCPAP group and 780 ± 239 [636, 924] mL kg−1 min−1 in the NIPPV group (P =.009). Blood gases were comparable in both groups. Conclusion: Irrespective of the noninvasive ventilatory support mode used, relatively high lung deposition rates of surfactant were achieved with nebulization. The amounts of deposited surfactant might suffice to elicit a pulmonary function improvement in the context of nRDS.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
aerosols, nebulizer, neonatal, noninvasive ventilation
in
Pediatric Pulmonology
volume
55
issue
2
pages
7 pages
publisher
John Wiley and Sons Inc.
external identifiers
  • pmid:31833668
  • scopus:85076824185
ISSN
8755-6863
DOI
10.1002/ppul.24603
language
English
LU publication?
yes
id
22fe5363-5bbc-47ba-b099-75d31b368881
date added to LUP
2020-01-10 12:37:42
date last changed
2020-07-08 05:10:35
@article{22fe5363-5bbc-47ba-b099-75d31b368881,
  abstract     = {<p>Background: Nasal continuous positive airway pressure support (nCPAP) is the standard of care for prematurely born infants at risk of neonatal respiratory distress syndrome (nRDS). However, nasal intermittent positive pressure ventilation (NIPPV) may be an alternative to nCPAP in babies requiring surfactant, and in conjunction with surfactant nebulization, it could theoretically reduce the need for invasive mechanical ventilation. We compared lung deposition of nebulized poractant in newborn piglets supported by nCPAP or NIPPV. Methods: Twenty-five sedated newborn piglets (1.2-2.2 kg) received either nCPAP (3 cmH<sub>2</sub>O, n = 12) or NIPPV (3 cmH<sub>2</sub>O positive end expiratory pressure+3 cmH<sub>2</sub>O inspiratory pressure, n = 13) via custom-made nasal prongs (FiO<sub>2</sub> 0.4, Servo-i ventilator). Piglets received 200 mg kg<sup>−1</sup> of technetium-99m-surfactant mixture continuously nebulized with a customized eFlow-Neos investigational vibrating-membrane nebulizer system. Blood gases were taken immediately before, during, and after nebulization. The deposition was estimated by gamma scintigraphy. Results: Mean surfactant deposition in the lungs was 15.9 ± 11.9% [8.3, 23.5] (mean ± SD [95% CI]) in the nCPAP group and 21.6 ± 10% [15.6, 27.6] in the NIPPV group (P =.20). Respiratory rates were similar in both groups. Minute volume was 489 ± 203 [360, 617] in the nCPAP group and 780 ± 239 [636, 924] mL kg<sup>−1</sup> min<sup>−1</sup> in the NIPPV group (P =.009). Blood gases were comparable in both groups. Conclusion: Irrespective of the noninvasive ventilatory support mode used, relatively high lung deposition rates of surfactant were achieved with nebulization. The amounts of deposited surfactant might suffice to elicit a pulmonary function improvement in the context of nRDS.</p>},
  author       = {Nord, Anders and Linner, Rikard and Salomone, Fabrizio and Bianco, Federico and Ricci, Francesca and Murgia, Xabi and Schlun, Martin and Cunha-Goncalves, Doris and Perez-de-Sa, Valeria},
  issn         = {8755-6863},
  language     = {eng},
  number       = {2},
  pages        = {514--520},
  publisher    = {John Wiley and Sons Inc.},
  series       = {Pediatric Pulmonology},
  title        = {Lung deposition of nebulized surfactant in newborn piglets : Nasal CPAP vs Nasal IPPV},
  url          = {http://dx.doi.org/10.1002/ppul.24603},
  doi          = {10.1002/ppul.24603},
  volume       = {55},
  year         = {2020},
}