Cunha-Goncalves Doris, Nord Anders, Bianco Federico, Salomone Fabrizio, Ricci Francesca, Schlun Martin, Linner Rikard, Perez-de-Sa Valeria
Department of Cardiothoracic Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden,
Department of Clinical Sciences, Lund University, Lund, Sweden,
Neonatology. 2020;117(4):467-473. doi: 10.1159/000508349. Epub 2020 Jun 30.
The ideal body position during surfactant nebulization is not known.
The aim of this study was to determine whether body positioning during surfactant nebulization influences surfactant distribution and deposition in the lungs.
Twenty-four 12- to 36-h-old full-termpiglets (1.3-2.2 kg) on nasal continuous positive airway pressure (nCPAP) were randomized into four groups: lateral decubitus with right or left side up, prone or supine positions (n = 6 each). All animals received 200 mg kg-1 of poractant alfa mixed with 200 MBq of 99mtechnetium-nanocolloid via a customized eFlow-Neos investigational vibrating-membrane nebulizer. Surfactant deposition (percentage of the administered dose) was measured by gamma scintigraphy.
Comparing all groups, the mean total lung surfactant deposition was significantly higher in the prone position (32.4 ± 7.7%, p = 0.03). The deposition in this group was higher in the right lung (21.0 ± 8.6 vs. 11.3 ± 5.7%, p = 0.04). When nebulization was performed in the lateral decubitus, most of the surfactant was found in the dependent lung, regardless of which side the piglet lay on (right side up 15.3 ± 1.0 vs. 3.4 ± 1.0%, p = 0.06, and left side up 11.2 ± 9.8 vs. 1.8 ± 0.7%, p = 0.04).
In spontaneously breathing animals on nCPAP, the prone position yielded the highest lung dose. Higher deposition rates in the dependent lung while on lateral decubitus indicates that deposition was also influenced by gravity.
目前尚不清楚表面活性剂雾化过程中的理想体位。
本研究旨在确定表面活性剂雾化过程中的体位是否会影响表面活性剂在肺内的分布和沉积。
将24只出生12至36小时、体重1.3至2.2千克、接受经鼻持续气道正压通气（nCPAP）的足月仔猪随机分为四组：右侧或左侧卧位、俯卧位或仰卧位（每组n = 6）。所有动物通过定制的eFlow-Neos研究型振动膜雾化器接受200毫克/千克的猪肺表面活性物质（poractant alfa）与200兆贝可的99m锝-纳米胶体混合液。通过γ闪烁显像法测量表面活性剂沉积（给药剂量的百分比）。
比较所有组，俯卧位时平均全肺表面活性剂沉积显著更高（32.4 ± 7.7%，p = 0.03）。该组右肺的沉积更高（21.0 ± 8.6% 对 11.3 ± 5.7%，p = 0.04）。当在侧卧位进行雾化时，无论仔猪哪侧卧位，大部分表面活性剂都在低位肺中发现（右侧卧位时为15.3 ± 1.0% 对 3.4 ± 1.0%，p = 0.06；左侧卧位时为11.2 ± 9.8% 对 1.8 ± 0.7%，p = 0.04）。
在接受nCPAP的自主呼吸动物中，俯卧位产生的肺内剂量最高。侧卧位时低位肺中更高的沉积率表明沉积也受重力影响。
