A SIMPLIFIED SURFACTANT DOSING PROCEDURE IN RESPIRATORY-DISTRESS SYNDROME - THE SIDE-HOLE RANDOMIZED STUDY

The aim of this study was to compare the incidence of acute adverse ev ents and long-term outcome of two different surfactant dosing procedur es in respiratory distress syndrome (RDS). The effects of two surfacta nt dosing procedures on the incidence of transient hypoxia and bradyca rdia, gas exchange, ventilatory requirements and 28 d outcome were com pared. The patients, comprising 102 infants (birthweight 600-2000 g) w ith RDS on mechanical ventilation with FiO2 greater than or equal to 0 .4, were randomized at 2-24 h to receive 200 mg kg(-1) of Curosurf(R); in 56 it was given by bolus delivery, and in 55 by a simplified techn ique (dose given in 1 min via a catheter introduced through a side-hol e in the tracheal tube adaptor. The baby's position was not changed an d ventilation was not interrupted). Two additional surfactant doses (1 00 mg kg(-1)) were also given, by the same method, if ventilation with FiO2 greater than or equal to 0.3 was needed 12 and 24 h after the in itial dose. The number of episodes of hypoxia and/or bradycardia was s imilar in both groups. A slight and transient increase in PaCO2 was ob served in the side-hole group. The efficacy of the surfactant, based o n oxygenation improvement, ventilator requirements, number of doses re quired and incidence of air leaks, was similar. No differences were ob served in the incidence of intraventricular haemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia or survival. In conclusion, a simplified surfactant dosing procedure not requiring fractional doses, ventilator disconnection, changes in the baby's position or manual ba gging was found to be as effective as bolus delivery. The number of do sing-related transient episodes of hypoxia and bradycardia was not dec reased by the slow, 1 min, side-hole instillation procedure.