Walther Frans J, Waring Alan J
Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States.
Front Pediatr. 2022 Jun 15;10:923010. doi: 10.3389/fped.2022.923010. eCollection 2022.
After shifting away from invasive mechanical ventilation and intratracheal instillation of surfactant toward non-invasive ventilation with nasal CPAP and less invasive surfactant administration in order to prevent bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome, fully non-invasive surfactant nebulization is the next Holy Grail in neonatology. Here we review the characteristics of animal-derived (clinical) and new advanced synthetic lung surfactants and improvements in nebulization technology required to secure optimal lung deposition and effectivity of non-invasive lung surfactant administration. Studies in surfactant-deficient animals and preterm infants have demonstrated the safety and potential of non-invasive surfactant administration, but also provide new directions for the development of synthetic lung surfactant destined for aerosol delivery, implementation of breath-actuated nebulization and optimization of nasal CPAP, nebulizer circuit and nasal interface. Surfactant nebulization may offer a truly non-invasive option for surfactant delivery to preterm infants in the near future.
为预防呼吸窘迫综合征早产儿发生支气管肺发育不良，从有创机械通气和气管内滴注表面活性剂转向经鼻持续气道正压通气（CPAP）的无创通气及侵入性较小的表面活性剂给药方式后，完全无创的表面活性剂雾化是新生儿学的下一个圣杯。在此，我们综述了动物源性（临床用）和新型先进合成肺表面活性剂的特性，以及确保无创肺表面活性剂给药的最佳肺内沉积和有效性所需的雾化技术改进。对表面活性剂缺乏动物和早产儿的研究已证明无创表面活性剂给药的安全性和潜力，同时也为开发用于气雾剂递送的合成肺表面活性剂、实施呼吸驱动雾化以及优化经鼻CPAP、雾化器回路和鼻接口提供了新方向。表面活性剂雾化可能在不久的将来为向早产儿递送表面活性剂提供一种真正无创的选择。
