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Innovation in surfactant therapy I: Surfactant lavage and surfactant administration by fluid bolus using minimally invasive techniques

Citation

Dargaville, PA, Innovation in surfactant therapy I: Surfactant lavage and surfactant administration by fluid bolus using minimally invasive techniques, Neonatology, 101, (4) pp. 326-336. ISSN 1661-7800 (2012) [Refereed Article]

Copyright Statement

Copyright 2012 S. Karger AG, Basel

Official URL: http://www.karger.com/Journal/Issue/256722

DOI: doi:10.1159/000337346

Abstract

Innovation in the field of exogenous surfactant therapy continues more than two decades after the drug became commercially available. One such innovation, lung lavage using dilute surfactant, has been investigated in both laboratory and clinical settings as a treatment for meconium aspiration syndrome (MAS). Studies in animal models of MAS have affirmed that dilute surfactant lavage can remove meconium from the lung, with resultant improvement in lung function. In human infants both non-randomised studies and two randomised controlled trials have demonstrated a potential benefit of dilute surfactant lavage over standard care. The largest clinical trial, performed by our research group in infants with severe MAS, found that lung lavage using two 15-ml/kg aliquots of dilute surfactant did not reduce the duration of respiratory support, but did appear to reduce the composite outcome of death or need for extracorporeal membrane oxygenation. A further trial of lavage therapy is planned to more precisely define the effect on survival. Innovative approaches to surfactant therapy have also extended to the preterm infant, for whom the more widespread use of continuous positive airway pressure (CPAP) has meant delaying or avoiding administration of surfactant. In an effort to circumvent this problem, less invasive techniques of bolus surfactant therapy have been trialled, including instillation directly into the pharynx, via laryngeal mask and via brief tracheal catheterisation. In a recent clinical trial, instillation of surfactant into the trachea using a flexible feeding tube was found to reduce the need for subsequent intubation. We have developed an alternative method of brief tracheal catheterisation in which surfactant is delivered via a semi-rigid vascular catheter inserted through the vocal cords under direct vision. In studies to date, this technique has been relatively easy to perform, and resulted in rapid improvement in lung function and reduced need for subsequent ventilation and duration of oxygen therapy. We are now commencing large-scale clinical trials of this method in preterm infants on CPAP.

Item Details

Item Type:Refereed Article
Keywords:meconium aspiration syndrome, surfactant lavage, continuous positive airway pressure
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Orthopaedics
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified
Author:Dargaville, PA (Professor Peter Dargaville)
ID Code:85090
Year Published:2012
Web of Science® Times Cited:16
Deposited By:Research Division
Deposited On:2013-06-13
Last Modified:2017-11-02
Downloads:0

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