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Aeration strategy at birth influences the physiological response to surfactant in preterm lambs

Citation

Tinga, DG and Togo, A and Pereira-Fantini, PM and Miedema, M and McCall, KE and Perkins, EJ and Thomson, J and Dowse, G and Sourial, M and Dellaca, RL and Davis, PG and Dargaville, PA, Aeration strategy at birth influences the physiological response to surfactant in preterm lambs, Archives of Disease in Childhood. Fetal and Neonatal Edition pp. F1-F7. ISSN 1359-2998 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 Author(s) (or their employer(s))

DOI: doi:10.1136/archdischild-2018-316240

Abstract

Background: The influence of pressure strategies to promote lung aeration at birth on the subsequent physiological response to exogenous surfactant therapy has not been investigated.

Objectives: To compare the effect of sustained inflation (SI) and a dynamic positive end-expiratory pressure (PEEP) manoeuvre at birth on the subsequent physiological response to exogenous surfactant therapy in preterm lambs.

Methods: Steroid-exposed preterm lambs (124–127 days’ gestation; n=71) were randomly assigned from birth to either (1) positive-pressure ventilation (PPV) with no recruitment manoeuvre; (2) SI until stable aeration; or (3) 3 min dynamic stepwise PEEP strategy (maximum 14–20 cmH2O; dynamic PEEP (DynPEEP)), followed by PPV for 60 min using a standardised protocol. Surfactant (200 mg/kg poractant alfa) was administered at 10 min. Dynamic compliance, gas exchange and regional ventilation and aeration characteristics (electrical impedance tomography) were measured throughout and compared between groups, and with a historical group (n=38) managed using the same strategies without surfactant.

Results: Compliance increased after surfactant only in the DynPEEP group (p<0.0001, repeated measures analysis of variance), being 0.17 (0.10, 0.23) mL/kg/cmH2O higher at 60 min than the SI group. An SI resulted in the least uniform aeration, and unlike the no-recruitment and DynPEEP groups, the distribution of aeration and tidal ventilation did not improve with surfactant. All groups had similar improvements in oxygenation post-surfactant compared with the corresponding groups not treated with surfactant.

Conclusions: A DynPEEP strategy at birth may improve the response to early surfactant therapy, whereas rapid lung inflation with SI creates non-uniform aeration that appears to inhibit surfactant efficacy.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Paediatrics and Reproductive Medicine
Research Field:Paediatrics
Objective Division:Health
Objective Group:Specific Population Health (excl. Indigenous Health)
Objective Field:Child Health
UTAS Author:Dargaville, PA (Professor Peter Dargaville)
ID Code:133072
Year Published:2019
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-06-06
Last Modified:2019-07-22
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