在接受持续气道正压通气的自主呼吸羔羊中进行声门上表面活性剂雾化

Supraglottic Atomization of Surfactant in Spontaneously Breathing Lambs Receiving Continuous Positive Airway Pressure.

作者信息

Milesi Ilaria, Tingay David G, Lavizzari Anna, Bianco Federico, Zannin Emanuela, Tagliabue Paolo, Mosca Fabio, Ventura Maria Luisa, Rajapaksa Anushi, Perkins Elizabeth J, Black Don, Di Castri Marco, Sourial Magdy, Pohlmann Gerhard, Dellaca' Raffaele L

机构信息

1Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy. 2Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia. 3Neonatology, The Royal Children's Hospital, Parkville, VIC, Australia. 4Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 5NICU, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 6Chiesi Corporate R&D, Chiesi Farmaceutici SpA, Parma, Italy. 7Neonatal Intensive Care Unit, Fondazione MBBM, Monza, Italy. 8Division of Translational Medical Engineering, Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.

出版信息

Pediatr Crit Care Med. 2017 Sep;18(9):e428-e434. doi: 10.1097/PCC.0000000000001267.

DOI:10.1097/PCC.0000000000001267

PMID:28742723

Abstract

OBJECTIVES

To determine the short-term tolerance, efficacy, and lung deposition of supraglottic atomized surfactant in spontaneously breathing lambs receiving continuous positive airway pressure.

DESIGN

Prospective, randomized animal study.

SETTING

Animal research laboratory.

SUBJECTS

Twenty-two preterm lambs on continuous positive airway pressure (132 ± 1 d gestational age).

INTERVENTIONS

Animals receiving continuous positive airway pressure via binasal prongs at 8 cm H2O were randomized to receive atomized surfactant at approximately 60-minute of life (atom; n = 15) or not (control; n = 7). The atom group received 200 mg/kg of poractant alfa (Curosurf; Chiesi Farmaceutici SpA, Parma, Italy) over 45 minutes via a novel atomizer located in the upper pharynx that synchronized surfactant delivery with the inspiratory phase.

MEASUREMENTS AND MAIN RESULTS

Arterial blood gas, regional distribution of tidal ventilation (electrical impedance tomography), and carotid blood flow were recorded every 15 minutes until 90 minutes after stabilizing on continuous positive airway pressure. Gas exchange, respiratory rate, and hemodynamic variables, including carotid blood flow, remained stable during surfactant treatment. There was a significant improvement in arterial alveolar ratio after surfactant delivery in the atom group (p < 0.05; Sidak posttests), while there was no difference in PaCO2. Electrical impedance tomography data showed a more uniform pattern of ventilation in the atom group. In the atom group, the median (interquartile range) deposition of surfactant in the lung was 32% (22-43%) of the delivered dose, with an even distribution between the right and the left lungs.

CONCLUSIONS

In our model of spontaneously breathing lambs receiving CPAP, supraglottic atomization of Curosurf via a novel device was safe, improved oxygenation and ventilation homogeneity compared with CPAP only, and provided a relatively large lung deposition suggesting clinical utility.

摘要

目的

确定在接受持续气道正压通气的自主呼吸羔羊中，声门上雾化表面活性剂的短期耐受性、疗效及肺内沉积情况。

设计

前瞻性、随机动物研究。

地点

动物研究实验室。

对象

22只接受持续气道正压通气的早产羔羊（胎龄132±1天）。

干预措施

通过双鼻导管以8 cmH₂O给予持续气道正压通气的动物被随机分为两组，一组在出生后约60分钟接受雾化表面活性剂治疗（雾化组；n = 15），另一组不接受治疗（对照组；n = 7）。雾化组通过位于上咽部的新型雾化器在45分钟内给予200 mg/kg的猪肺磷脂（固尔苏；基耶西制药公司，帕尔马，意大利），该雾化器可使表面活性剂的输送与吸气相同步。

测量指标及主要结果

在稳定接受持续气道正压通气后，每隔15分钟记录动脉血气、潮气量区域分布（电阻抗断层成像）及颈动脉血流，直至90分钟。在表面活性剂治疗期间，气体交换、呼吸频率及包括颈动脉血流在内的血流动力学变量保持稳定。雾化组在给予表面活性剂后动脉肺泡比有显著改善（p < 0.05；Sidak事后检验），而动脉血二氧化碳分压无差异。电阻抗断层成像数据显示雾化组通气模式更均匀。在雾化组，表面活性剂在肺内的沉积中位数（四分位间距）为给予剂量的32%（22 - 43%），左右肺分布均匀。