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Aeration strategy at birth influences the physiological response to surfactant in preterm lambs

Tinga, DG, Togo, A, Pereira-Fantini, PM, Miedema, M, McCall, KE, Perkins, EJ, Thomson, J, Dowse, G, Sourial, M, Dellaca, RL, Davis, PG and Dargaville, PA 2019 , 'Aeration strategy at birth influences the physiological response to surfactant in preterm lambs' , Archives of Disease in Childhood. Fetal and Neonatal Edition , F1-F7 , doi: 10.1136/archdischild-2018-316240.

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Abstract

Background: The influence of pressure strategies to promote lung aeration at birth on the subsequent physiological response to exogenous surfactant therapy has not been investigated.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 (p2O 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: Article
Authors/Creators: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
Journal or Publication Title: Archives of Disease in Childhood. Fetal and Neonatal Edition
Publisher: BMJ Group
ISSN: 1359-2998
DOI / ID Number: 10.1136/archdischild-2018-316240
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Copyright 2019 Author(s) (or their employer(s))

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