Nebulization of High-Dose Poractant Alfa in Newborn Piglets on Nasal Continuous Positive Airway Pressure Yields Therapeutic Lung Doses of Phospholipids
| Autor: | Doris Cunha-Goncalves, Federico Bianco, Fabrizio Salomone, Anders Nord, Rikard Linner, Martin Schlun, Francesca Ricci |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Neonatal respiratory distress syndrome
Swine medicine.medical_treatment Surface-Active Agents 03 medical and health sciences 0302 clinical medicine Pulmonary surfactant 030225 pediatrics medicine Animals Humans Poractant alfa Oximetry 030212 general & internal medicine Continuous positive airway pressure Lung Phospholipids Aerosolization Biological Products Respiratory Distress Syndrome Newborn Continuous Positive Airway Pressure Mean lung dose business.industry Infant Newborn Obstetrics and Gynecology Pulmonary Surfactants medicine.disease Nebulizer medicine.anatomical_structure Animals Newborn Cerebrovascular Circulation Anesthesia Pediatrics Perinatology and Child Health business medicine.drug |
| Zdroj: | American Journal of Perinatology. 39:1001-1007 |
| ISSN: | 1098-8785 0735-1631 |
| DOI: | 10.1055/s-0040-1721392 |
| Popis: | Objective: It is not known how much surfactant must be nebulized to reach a lung dose of phospholipids equivalent to that obtained by the instillation of 200 mg/kg of surfactant. We aimed to assess the feasibility of nebulizing a high-dose of poractant alfa with the eFlow-Neos investigational vibrating-membrane nebulizer in newborn piglets on nasal continuous positive airway pressure (nCPAP) and to determine whether this intervention would yield therapeutic lung doses of phospholipids. Study Design: Twelve 1-day-old piglets on nCPAP received 600 mg/kg of poractant alfa admixed with technetium-99m via nebulization. Six piglets receiving 200 mg/kg of instilled synthetic surfactant served as controls. Lung deposition (percentage of the nominal dose) was determined by gamma scintigraphy, and the phospholipids' lung dose was calculated. Results: The lung dose of phospholipids (mean ± standard deviation [SD]) was 138 ± 96 mg/kg with nebulization, and 172 ± 24 mg/kg with instillation (p = 0.42). Nebulization took 58 ± 12 minutes. The arterial partial pressure of carbon dioxide increased from 6.7 ± 1.1 to 7.2 ± 1.1 kPa during nebulization (p = 0.04). Cerebral oximetry remained stable, and there was no hemodynamic instability. Conclusion: Nebulization was well tolerated, and the mean lung dose of phospholipids was above 100 mg/kg, that is, not different from the instillation group. These experimental findings suggest that it may be feasible to reach therapeutic lung doses of phospholipids by surfactant nebulization during nCPAP. Key Points It is not known if effective lung doses of surfactant can be delivered by nebulization. Nebulization of high-dose surfactant in newborn piglets on nCPAP was well tolerated. A high-dose of nebulized poractant alfa yielded therapeutic lung doses of phospholipids. (Less) |
| Databáze: | OpenAIRE |
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