Effects of exogenous surfactant therapy on dynamic compliance during mechanical breathing in preterm infants with hyaline membrane disease

https://doi.org/10.1016/S0022-3476(05)81660-9Get rights and content

In a prospective, randomized, controlled clinical trial, the immediate and the longitudinal effects of exogenous surfactant therapy on pulmonary mechanics were evaluated in extremely premature infants during mechanical respiration. Ninety-four infants weighing between 600 and 1250 gm received either exogenous surfactant or sham (air) therapy in the delivery room and up to three additional doses in the first 48 hours of the life if they were ventilator-dependent, had fractional inspiratory oxygen requirements > 0.30, and radiographic findings consistent with hyaline membrane disease. Each infant underwent pulmonary mechanics assessment (dynamic compliance, total pulmonary resistance, fidal volume) immediately before and 1 hour after each dose, and at 24, 48, and 72 hours and 7 days of age. There were no significant differences in dynamic compliance, total pulmonary resistance, and tidal volume in the surfactant (n=47) and control (n=47) groups before and 1 hour after each dose. However, dynamic compliance was 50% greater in the surfactant group at 24 hours of age (p≤0.009); this difference steadily increased to 94% at 7 days of age (p≤0.009). Oxygenation, assessed by the ratio of alveolar to arterial oxygen pressure, was significantly greater in the surfactant group during the first 72 hours of life; the greatest difference was noted at 24 hours (p≤0.001). Mean airway pressure requirements in the surfactant group were significantly less than in the control group at all times during the first week. We conclude that exogenous surfactant therapy, administered at birth and during the first 48 hours of life in extremely premature infants with hyaline membrane disease, improves dynamic compliance and gas exchange during mechanical breathing.

References (16)

There are more references available in the full text version of this article.

Cited by (94)

  • Exogenous surfactant therapy

    2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh Edition
  • Pharmacologic Therapies I: Surfactant Therapy

    2017, Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care: Sixth Edition
  • Effect of Minimally Invasive Surfactant Therapy on Lung Volume and Ventilation in Preterm Infants

    2016, Journal of Pediatrics
    Citation Excerpt :

    The effect of surfactant administration via an endotracheal tube during both conventional and high-frequency ventilation on EELV has been studied extensively in preterm infants. Surfactant increases EELV and, furthermore, this effect is most prominent in the dependent lung regions, suggesting a gravity-dependent distribution15,23; however, there are fundamental differences between MIST and surfactant treatment during mechanical ventilation, such as a slower rate of surfactant infusion and the absence of positive pressure inflations during MIST, which may impact surfactant distribution and its effect on EELV.24 The present study shows that MIST also leads to an increase in EELV, starting at the time of surfactant infusion and stabilization within 5 minutes after administration.

  • Pharmacologic Adjuncts II. Exogenous Surfactants

    2011, Assisted Ventilation of the Neonate
  • Pharmacologic adjuncts ii: Exogenous surfactants exogenous surfactants

    2010, Assisted Ventilation of the Neonate: Expert Consult - Online and Print
View all citing articles on Scopus
View full text