Is Less Invasive Surfactant Administration Necessary or “Only” Helpful or Just a Fashion?

2018 ◽  
Vol 35 (06) ◽  
pp. 530-533 ◽  
Author(s):  
Ilia Bresesti ◽  
Laura Fabbri ◽  
Gianluca Lista
Keyword(s):  
Large Scale ◽  
Exogenous Surfactant ◽  
Preterm Neonates ◽  
Positive Pressure ◽  
Less Invasive ◽  
Antenatal Steroids ◽  
Surfactant Replacement Therapy ◽  
Short And Long Term ◽  
Surfactant Administration ◽  
A New Technique

AbstractIn the 1990s, the most relevant pillars in the treatment of neonatal respiratory distress syndrome (RDS) have been improvements in ventilation strategies, the introduction of exogenous surfactant replacement therapy, and the use of antenatal steroids. Lately, in addition to the standard INSURE (INtubation–SURfactant administration–Extubation) method to administer surfactant, a new technique has been gaining increasing popularity. It is the so-called less invasive surfactant administration (LISA) method, which has shown promising results in preventing bronchopulmonary dysplasia development and in reducing mortality in preterm neonates. The rationale behind this technique is to avoid positive pressure ventilation and the endotracheal tube, being surfactant delivered through a thin catheter while the neonate is maintained on continuous positive airway pressure. Given the paucity of large-scale randomized trials on LISA method to prove its effects on short- and long-term outcomes, some questions still remain unanswered. Then, uncertainty regarding the feasibility of this maneuver needs to be better clarified before gaining wide acceptance in routine clinical practice. In our report, we aim at hypothesizing the main mechanisms behind the efficacy of LISA, considering it as a single maneuver in a comprehensive approach for RDS management in the delivery room.

scholarly journals NeoLISA - A new method of surfactant administration developed based on in situ simulation 

2020 ◽  
Author(s):  
Shilpa Kalane ◽  
Arti Rajhans ◽  
Rajan Joshi
Keyword(s):  
Respiratory Distress ◽  
New Method ◽  
Exogenous Surfactant ◽  
Preterm Neonates ◽  
Catheter Position ◽  
In Situ Simulation ◽  
Mortality And Morbidity ◽  
Clinical Method ◽  
Less Invasive ◽  
Surfactant Administration

Abstract Background: Respiratory distress syndrome (RDS) caused by surfactant deficiency is the major cause of respiratory distress in preterm neonates. Despite the advances in preventive interventions, RDS may still develop and be associated with acute and or chronic complications. Exogenous surfactant therapy is effective in reducing RDS related mortality and morbidity. Due to the complications of surfactant administration, minimal or less invasive administration techniques have been developed and appear promising. Objective: To address the knowledge gaps in less invasive surfactant administration technique at the level of the health care worker (HCW). Methodology: Four simulation-training sessions were conducted in April 2020, two before and two after the NeoLISA technique was developed. The neonatal clinical team consisted of neonatology specialists and neonatal nurses. Results: Each simulation session lasted for around 30 minutes including debriefing. The learnings during this process were discussed and the new technique of NeoLISA was developed. The key change was the development to confirm the catheter position.Conclusion: A new method for surfactant administration was developed. An innovative bedside clinical method confirming catheter position into the trachea has been developed.

scholarly journals Study Of The Outcome Of Early And Late Rescue Surfactant Administration In Preterm Babies

2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Jayachandra Naidu T ◽  
Kireeti AS ◽  
Lokesh B ◽  
Shankar Reddy Dudala
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surfactant Therapy ◽  
Preterm Neonates ◽  
P Value ◽  
Surfactant Replacement Therapy ◽  
Preterm Babies ◽  
Surfactant Administration

Introduction: Respiratory Distress Syndrome (RDS) is a common cause of mortality and morbidity in preterm. It is the commonest indication for ventilation in neonates in India. Surfactant Replacement Therapy (SRT) for RDS is a major breakthrough that has revolutionized the survival of premature infants worldwide. Randomized controlled trials have also demonstrated that prophylactic or early surfactant therapy compared with delayed surfactant treatment results in improved outcomes for preterm infants at high risk. Objective: To assess the outcome of early and late rescue surfactant administration by InSuRE (Intubation, Surfactant and Rapid Extubation) technic in managing preterm neonates with respiratory distress syndrome (RDS). Methodology: Study design: Prospective analytical study. Sample size: 144 preterm babies between 28-34 weeks of GA. Setting: Level III NICU at SVRR Government General Hospital, Tirupati, AP. Study Period: 1 year (Sep 2013 to Aug 2014). Method: All preterm babies between 28-34 weeks with respiratory distress were given surfactant with InSuRE technic immediately and categorized into early and late rescue group depending on the time of surfactant therapy i.e. within 2 hrs. of life and between 2-24 hrs. of life respectively. Results: In early rescue group there is significant reduction in mortality and lessen the need of mechanical ventilation with p value <0.05. Conclusion: Early routine surfactant administration within 2 hrs. of life as compared to late selective administration significantly reduced the need mechanical ventilation within 7th day of life and mortality among preterm with respiratory distress syndrome.

scholarly journals Less invasive surfactant administration (LISA): chances and limitations

2019 ◽  
Vol 104 (6) ◽  
pp. F655-F659 ◽  
Author(s):  
Egbert Herting ◽  
Christoph Härtel ◽  
Wolfgang Göpel
Keyword(s):  
Spontaneous Breathing ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Invasive Approach ◽  
Less Invasive ◽  
Non Invasive ◽  
Adequate Dose ◽  
Open Questions ◽  
Surfactant Administration ◽  
Meta Analyses

Non-invasive ventilation and especially the application of continuous positive airway pressure (CPAP) has become standard for the treatment of premature infants with respiratory problems. However, CPAP failure may occur due to respiratory distress syndrome, that is, surfactant deficiency. Less invasive surfactant administration (LISA) aims to provide an adequate dose of surfactant while the infant is breathing spontaneously, thus avoiding positive pressure ventilation support. Using a thin catheter for surfactant application allows infants to maintain function of the glottis and continue spontaneous breathing, whereas the INtubate-SURfactant-Extubate (INSURE) procedure is connected with sedation/analgesia, regular intubation and a (brief) period of positive pressure ventilation. Individual studies and meta-analyses summarised in this review point in the direction that LISA is more effective than standard treatment or INSURE both in terms of short-term (avoidance of mechanical ventilation) and long-term (intracerebral haemorrhage and bronchopulmonary dysplasia) outcomes. Open questions include exact treatment thresholds for different gestational ages, the usefulness of devices/catheters that have recently been purpose-built for the LISA technique and especially the question of analgesia/sedation during the procedure. The current technology still demands laryngoscopy with all its unpleasant effects for infants. Therefore, studies with pharyngeal surfactant deposition immediately after delivery, the use of laryngeal airways for surfactant administration and attempts to nebulise surfactant are under way. Finally, LISA is not simply an isolated technical procedure for surfactant delivery but rather part of a comprehensive non-invasive approach supporting the concept of a gentle transition to the extrauterine world enabling preterm infants to benefit from the advantages of spontaneous breathing.

scholarly journals The Miracles of Surfactant: Less Invasive Surfactant Administration, Nebulization, and Carrier of Topical Drugs

Neonatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Christoph Härtel ◽  
Kirsten Glaser ◽  
Christian P. Speer
Keyword(s):  
Replacement Therapy ◽  
Preterm Infants ◽  
Invasive Mechanical Ventilation ◽  
Lung Surfactant ◽  
Standard Of Care ◽  
Less Invasive ◽  
Surfactant Replacement Therapy ◽  
Surfactant Administration ◽  
Invasive Techniques ◽  
Spontaneously Breathing

Surfactant replacement therapy (SRT) has long become the standard of care in the treatment of neonatal respiratory distress syndrome (RDS), significantly decreasing acute pulmonary morbidity and mortality in preterm infants. For decades, this beneficial replacement therapy has been administered via endotracheal tube. Despite significantly improving the outcome of RDS, however, the burden of bronchopulmonary dysplasia remains, in particular, in very immature preterm infants. Acknowledging the direct relationship between exposure to and duration of invasive mechanical ventilation and chronic lung disease, the latter has been gradually replaced by noninvasive ventilation strategies in neonatal RDS. This replacement is strongly related to the demand for similarly noninvasive modes of surfactant administration. Alternative techniques in spontaneously breathing infants have evolved, including less invasive techniques using thin catheters (less invasive surfactant administration and minimally invasive surfactant treatment) as well as nebulization of surfactant, although the latter is not ready for clinical application yet. In addition, given their therapeutic delivery to the lungs and subsequent alveolar distribution, surfactant preparations represent an attractive vehicle for pulmonary deposition of drugs in preterm infants. Further improvement of SRT and expansion of the field of application of lung surfactant may hold additional benefits, especially in the treatment of the most immature preterm infants.

Review demonstrates that less invasive surfactant administration in preterm neonates leads to fewer complications

2018 ◽  
Vol 107 (5) ◽  
pp. 736-743 ◽  
Author(s):  
Ludwig Gortner ◽  
Simone S. Schüller ◽  
Egbert Herting
Keyword(s):  
Preterm Neonates ◽  
Less Invasive ◽  
Surfactant Administration

scholarly journals A Novel Iron Chloride Red-Ox Concentration Flow Cell Battery (ICFB) Concept; Power and Electrode Optimization

Energies ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 1109
Author(s):  
Robert Bock ◽  
Björn Kleinsteinberg ◽  
Bjørn Selnes-Volseth ◽  
Odne Stokke Burheim
Keyword(s):  
Energy Storage ◽  
Large Scale ◽  
Fossil Fuels ◽  
Flow Cell ◽  
Iron Chloride ◽  
Carbon Electrodes ◽  
Concentration Difference ◽  
Term Energy ◽  
Short And Long Term

For renewable energies to succeed in replacing fossil fuels, large-scale and affordable solutions are needed for short and long-term energy storage. A potentially inexpensive approach of storing large amounts of energy is through the use of a concentration flow cell that is based on cheap and abundant materials. Here, we propose to use aqueous iron chloride as a reacting solvent on carbon electrodes. We suggest to use it in a red-ox concentration flow cell with two compartments separated by a hydrocarbon-based membrane. In both compartments the red-ox couple of iron II and III reacts, oxidation at the anode and reduction at the cathode. When charging, a concentration difference between the two species grows. When discharging, this concentration difference between iron II and iron III is used to drive the reaction. In this respect it is a concentration driven flow cell redox battery using iron chloride in both solutions. Here, we investigate material combinations, power, and concentration relations.

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