Influence of catheter thickness on respiratory physiology during less invasive surfactant administration in extremely preterm infants.

Autor:	Gunatilaka CC; Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States., Xiao Q; Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States., Bates AJ; Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States., Franz AR; Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany.; Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Germany., Poets CF; Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany., Maiwald CA; Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany.; Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in pediatrics [Front Pediatr] 2024 Sep 17; Vol. 12, pp. 1352784. Date of Electronic Publication: 2024 Sep 17 (Print Publication: 2024).
DOI:	10.3389/fped.2024.1352784
Abstrakt:	Introduction: Delivering surfactant via thin catheters (minimal-invasive surfactant therapy (MIST); less invasive surfactant administration (LISA)) has become a common procedure. However, the effect of tracheal obstruction caused by catheters of different sizes on tracheal resistance in extremely low gestational age newborns (ELGANs) is unknown. Methods: To investigate the effect of catheters size 3.5, 5 and 6 French on airway resistance in ELGANs of 23-28 weeks gestational age during LISA, we performed calculations based on Hagen-Poiseuille's law and compared these with a clinically and physically more accurate method: computational fluid dynamics (CFD) simulations of respiratory airflow, performed in 3D virtual airway models derived from MRI. Results: The presence of the above catheters decreased the cross-sectional area of the infants' tracheal entrance (the cricoid ring) by 13-53%. Hagen-Poiseuille's law predicted an increase in resistance by 1.5-4.5 times and 1.3-2.6 times in ELGANs born at 23 and 28 weeks, respectively. However, CFD simulations demonstrated an even higher increase in resistance of 3.4-85.1 and 1.1-3.5 times, respectively. The higher calculated resistances were due to the extremely narrow remaining lumen at the glottis and cricoid with the catheter inserted, resulting in a stronger glottal jet and turbulent airflow, which was not predicted by Hagen-Poiseuille. Conclusion: Catheter thickness can greatly increase tracheal resistance during LISA-procedures in ELGANs. Based on these models, it is recommended to use the thinnest catheter possible during LISA in ELGANs to avoid unnecessary increases in airway resistance in infants already experiencing dyspnea due to respiratory distress syndrome. Competing Interests: CA Maiwald has a financial relationship in the profits of the Neofact® product as inventor (Murrplastik Medizintechnik GmbH, Germany) and his research projects on LISA are, in part, supported by Lyomark Pharma GmbH, Germany. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2024 Gunatilaka, Xiao, Bates, Franz, Poets and Maiwald.)
Databáze:	MEDLINE
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