A. Vallsisoler et al., A SIMPLIFIED SURFACTANT DOSING PROCEDURE IN RESPIRATORY-DISTRESS SYNDROME - THE SIDE-HOLE RANDOMIZED STUDY, Acta paediatrica, 86(7), 1997, pp. 747-751
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.