2009 OPEN FORUM Abstracts
DOES THE TIME POST DELIVERY OF SURFACTANT ADMINISTRATION HAVE IMPACT ON THE DURATION OF VENTILATION IN PREMATURE INFANTS WITH RESPIRATORY DISTRESS SYNDROME?
Khin-Kyemon Aung1,2, Daniel W. Sutton1,2, Susan M. Brant1,2, John Dickson1,2, Robert L. Chatburn2, Firas Saker1,2; 1Hillcrest Hospital, Mayfield Heights, OH; 2Cleveland Clinic, Cleveland, OH
BACKGROUND: Conventional mechanical ventilation is a common modality that has significantly reduced the number of mortalities in very low birth weight infants (VLBW) with respiratory distress syndrome (RDS). However, extended duration on mechanical ventilation can lead to bronchopulmonary dysplasia, lung inflammation, chronic lung disease and other complications for neonates. Surfactant replacement therapy has been proven to reduce mortality and associated morbidities such as duration on mechanical ventilation in RDS patients. Data collected from our institution indicate a large variability in the time between birth and surfactant delivery and also duration on mechanical ventilation. Few data are available comparing treatment delay to outcome. The purpose of this study was to determine if there is a correlation between the surfactant delivery time and the duration of ventilation. METHODS: Data from 2004-2007 for VLBW neonates were collected from the Vermont-Oxford and the Hillcrest Hospital database. Records of 127 neonates were reviewed with 44 meeting the criteria (RDS, mechanical ventilation only, surfactant administration); 9 were excluded due to death, transfer or incomplete information plus one outlier. Surfactant delay (SD) was defined as time (minutes) from birth to the first surfactant dose and duration of ventilation (DV) was defined as the time (minutes) from intubation to extubation. Linear correlation and percentile analyses were used to evaluate the association between SD and DV. RESULTS: Gestational age ranged from 22-32 weeks. SD ranged from 7-207 min and DV ranged from 20-4,775 min. The 85th percentile for SD was 60 min and the 85th percentile for DV was 2,250 min. The figure shows SD versus DV. The low r value indicates virtually no correlation. A subset of the data (gestational age 29- 31 weeks, n=20) was analyzed with comparable results. CONCLUSION: In this group of patients, the delay in surfactant delivery for up to four hours appears to have no association with duration of ventilation. However, a majority of patients in our study received surfactant within an hour. We speculate that the shorter the duration of ventilation before surfactant delivery, the lesser the risk of ventilator-induced injury and hence the lack of an association. These results provide benchmark data for further studies and suggest that efforts to improve protocol compliance related to treatment delay would be unnecessary. Sponsored Research - None