The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts


Ryan Berg RRT, Ron Haskell RRT, Cathy Brower RRT, Kari Wood MSN Dale Gerstmann MD, Gordon Lassen RRT, Ronald Stoddard MD, Stephen Minton MD. Neonatology, Utah Valley Regional Medical Center, Provo, UT.

Objective: The purpose of this study was to explore and compare the immediate (24h) clinical responses following administration of surfactant with two modes of ventilation, namely, CV and HFOV. The hypothesis being that the clinical response following surfactant administration with HFOV is not worse than the clinical response following surfactant administration with CV.

Design: Following IRB approval of the study, infants <37wks GA who were determined by the attending neonatologist to require intubation, surfactant treatment and assisted ventilation were recruited for the study. Patients were randomized to receive rescue surfactant either with CV or with HFOV. All patients were placed on HFOV following intubation and before surfactant was administered. Specified ventilator changes were made to promote lung recruitment, then surfactant was administered during ventilation with CV or HFOV, then HFOV was resumed using a structured ventilator adjustment protocol in response to SpO2, TcPCO2, and ABG values. The following parameters were monitored: FiO2, CDP, delP, SpO2, TcPCO2, HR, RR, and BP. Monitoring occurred for 1 hour prior to surfactant, and post surfactant q1min to 10min, q10min to 60min, then q1h to 24h. Data were analyzed by ventilator group within an analysis of variance for repeated measures model.

Results: Data are reported on 16 patients, 8 randomized to receive surfactant with CV and 8 with HFOV. Mean birth weight, gestational age and age at surfactant were 2115g, 33wk and 3.8h, respectively. Except for a higher respiratory rate in infants that would receive surfactant with HFOV (p<0.018), parameters were equivalent prior to surfactant. For the 24 hours following surfactant, BPsystolic (p=0.001), BPdiastolic (p<0.001), HR (p=0.008) and SpO2 (p=0.012) were higher, and CDP (p<0.001) and TcPCO2 (p<0.001) were lower in the group that received surfactant with HFOV compared to the group that received surfactant with CV. Although not a statistically significant difference, it is of note that 4 of 8 patients in the HFOV administration group versus 1 of 8 patients in the CV administration group were extubated by 24h.

Conclusion In HFOV treated neonates whose ventilator adjustments were managed the same before and for 24h following surfactant administration, these preliminary data suggest that cardio respiratory stability, oxygenation and ventilation may be no worse if initial surfactant is administered during HFOV, as compared to initial surfactant being administered with CV, which is the manufacturers' recommendation.

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