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, 104, (6) pp. F587-F593. ISSN 1359-2998 (2019) [Refereed Article]
Copyright 2019 Author(s) (or their employer(s))
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 Type:||Refereed Article|
|Research Division:||Biomedical and Clinical Sciences|
|Objective Group:||Specific population health (excl. Indigenous health)|
|Objective Field:||Neonatal and child health|
|UTAS Author:||Dargaville, PA (Professor Peter Dargaville)|
|Web of Science® Times Cited:||8|
|Deposited By:||Menzies Institute for Medical Research|
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