title: Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome.
abstract: Aerosolization of exogenous surfactant remains a challenge. This study is aimed to evaluate the efficacy of atomized poractant alfa (Curosurf) administered with a novel atomizer in preterm lambs with respiratory distress syndrome.
  
  
  
  Twenty anaesthetized lambs, 127 ± 1 d gestational age, (mean ± SD) were instrumented before birth and randomized to receive either (i) positive pressure ventilation without surfactant (Control group), (ii) 200 mg/kg of bolus instilled surfactant (Bolus group) at 10 min of life or (iii) 200 mg/kg of atomized surfactant (Atomizer group) over 60 min from 10 min of life. All lambs were ventilated for 180 min with a standardized protocol. Lung mechanics, regional lung compliance (electrical impedance tomography), and carotid blood flow (CBF) were measured with arterial blood gas analysis.
  
  
  
  Dynamic compliance and oxygenation responses were similar in the Bolus and Atomizer groups, and both better than Control by 180 min (all P < 0.05; two-way ANOVA). Both surfactant groups demonstrated more homogeneous regional lung compliance throughout the study period. There were no differences in CBFConclusion:In a preterm lamb model, atomized surfactant resulted in similar gas exchange and mechanics as bolus administration. This study suggests evaluation of supraglottic atomization with this system when noninvasive support is warranted.
authors.affiliation: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Milesi
authors.affiliation: Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia.|Neonatology, The Royal Children's Hospital, Parkville, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: David G
authors.identifier: 0000-0003-1522-4691
authors.initials: DG
authors.lastname: Tingay
authors.affiliation: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Zannin
authors.affiliation: Research and Development Department, Chiesi Farmaceutici SpA, Parma, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Bianco
authors.affiliation: Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tagliabue
authors.affiliation: NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università degli Studi di Milano.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
authors.affiliation: NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico-Università degli Studi di Milano.
authors.forename: Anna
authors.initials: A
authors.lastname: Lavizzari
authors.affiliation: Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Ventura
authors.affiliation: Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: C Elroy
authors.initials: CE
authors.lastname: Zonneveld
authors.affiliation: Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Perkins
authors.affiliation: Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Don
authors.initials: D
authors.lastname: Black
authors.affiliation: Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Magdy
authors.initials: M
authors.lastname: Sourial
authors.affiliation: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy.
authors.forename: Raffaele L
authors.initials: RL
authors.lastname: Dellacá
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001688:Biological Products / Q000008:administration & dosage* / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics; D006863:Hydrogen-Ion Concentration; D008168:Lung / Q000502:physiology; D008297:Male; D009330:Nebulizers and Vaporizers; D010100:Oxygen / Q000737:chemistry; D010743:Phospholipids / Q000008:administration & dosage* / Q000627:therapeutic use*; D011312:Pressure; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use*; D011897:Random Allocation; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000503:physiopathology; D012756:Sheep; D013501:Surface-Active Agents; D013997:Time Factors
chemical_list: D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; D013501:Surface-Active Agents; C068291:poractant alfa; D010100:Oxygen