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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 7/2010

01.07.2010 | Original

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

verfasst von: Pierre Tissières, Patrick Myers, Maurice Beghetti, Michel Berner, Peter C. Rimensberger

Erschienen in: Intensive Care Medicine | Ausgabe 7/2010

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Abstract

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 × FiO2 > 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.
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Metadaten
Titel
Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants
verfasst von
Pierre Tissières
Patrick Myers
Maurice Beghetti
Michel Berner
Peter C. Rimensberger
Publikationsdatum
01.07.2010
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 7/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-1838-0

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