Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants

Autor: Michel Berner, Patrick Olivier Myers, Pierre Tissières, Peter C. Rimensberger, Maurice Beghetti
Jazyk: angličtina
Rok vydání: 2018
Předmět:
medicine.medical_treatment
High-Frequency Ventilation
Critical Care and Intensive Care Medicine
Respiratory Insufficiency/therapy
Respiratory Distress Syndrome
Newborn/ therapy
Intensive care
medicine
Humans
Infant
Very Low Birth Weight
Lung volumes
Prospective Studies
Ductus Arteriosus
Patent
Mechanical ventilation
Continuous Positive Airway Pressure/ methods
Respiratory Distress Syndrome
Newborn
High-Frequency Ventilation/ methods
ddc:618
Respiratory distress
Continuous Positive Airway Pressure
ddc:617
business.industry
Pulmonary Surfactants/ administration & dosage
Infant
Newborn
Pulmonary Surfactants
medicine.disease
Outcome and Process Assessment (Health Care)
Low birth weight
Outcome and Process Assessment
Health Care
Bronchopulmonary dysplasia
Respiratory failure
Anesthesia
Breathing
medicine.symptom
business
Respiratory Insufficiency
Zdroj: Intensive Care Medicine, Vol. 36, No 7 (2010) pp. 1164-1170
ISSN: 0342-4642
Popis: PURPOSE: Early lung recruitment (ELR) during high-frequency oscillatory ventilation (HFOV) in combination with prophylactic surfactant use has been reported to reduce mortality, improve respiratory outcomes, and reduce the need for repeated surfactant dosing, suggesting that surfactant might be used more selectively in very low birth weight (VLBW) infants on HFOV than generally recommended. We report our first experience from such a selective early rescue use of surfactant in VLBW infants on HFOV. METHODS: After a deliberate ELR maneuver and "optimal" continuous distending pressure (CDP) finding during HFOV, used as primary ventilation mode for VLBW infants with respiratory distress syndrome (RDS), surfactant was only given when an unsatisfactory oxygenation response to lung recruitment (as defined by CDP x FiO(2) > 5) was observed. RESULTS: Out of 144 VLBW infants on HFOV, 84 (58.3%) received surfactant and 60 (41.7%) did not. Duration of required oxygen supplementation (37.4 +/- 44.9 vs. 46.2 +/- 35.4 days; P = 0.031) and respiratory support (i.e., n-CPAP and/or mechanical ventilation; 22.3 +/- 19.3 vs. 38.2 +/- 24.3 days; P = 0.001) was shorter for infants who did not receive surfactant than for those who did. The incidence and severity of bronchopulmonary dysplasia was similar in both groups, and there was no difference in survival rates between groups. Subgroup analysis for infants of less than 28 weeks of gestation revealed similar results. CONCLUSIONS: First intention HFOV combined with an early attempt at lung volume optimization might allow surfactants to be used more selectively (in relation to disease severity) in VLBW infants presenting with RDS at birth without negatively influencing the outcome.
Databáze: OpenAIRE
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