China
Africa
Explore chapters and articles related to this topic
Surfactant aerosol therapy for nRDS and ARDS
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
In clinical studies using a capillary condensation aerosol generator for transnasal surfactant aerosol delivery, the efficiency of delivery appears to be very low. When aerosolizing 60 mL of 30 mg/mL of KL4 (Lucinactant) surfactant at 1.2 mL/min over 50 minutes, 80 mg of the original 1.8 grams of phospholipid was aerosolized. The aerosolized surfactant was delivered to the neonate at 100 mg of phospholipid per hour through nasal prongs at 3 L/min. Based on a minute ventilation of 300 mL/min, just 0.16 mg/min phospholipid in the 2.8 µm MMAD aqueous aerosol would have been inhaled. In monkeys, when this aerosol was delivered through nasal prongs at 3 L/min at 5 cm water nPAP, over 5- to 9-minute period, regionally 80% was deposited in the nose and mouth and 11% was deposited in the lungs (102,103). Also, during a 50-minute treatment period, it is estimated that 2.8 mL may be presented to the nasal passages. There is a possibility that the accumulated fluid in the nasal passages could cause irritation and/or obstruction. It is possible that the lack of additional benefits observed following 2 hours rather than 1 hour of surfactant administration in a clinical trial was due to adverse effects associated with this lengthy treatment regimen rather than too much phospholipid. In this regard, KL4 surfactant was aerosolized and emitted at a rate of 22.5 mg/min in 6 L/min (1.356 grams) at the ventilator connector over a period of 1 hour and delivered to 1.8 kg newborn pigs using oropharyngeal CPAP (67). The phospholipid concentration of the aerosolized surfactant was 3.7 mg/L. The aerosolized KL4 surfactant was superior to the KL4 given by instillation. In a recent clinical trial by Windtree, the endpoints were not met. However, when Windtree conducted a post-hoc analysis of the neonatal data, they claimed that a subsection of this treated population, in which aerosol treatment was not compromised by technical difficulties, showed an increase in the time to intubation as well as a corresponding decrease in the need for intubation.
Advances in the Pharmacological Management of Pediatric Acute Respiratory Distress Syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Maria Gabriella Matera, Francesco Imperatore, Rosa Annibale, Mario Cazzola
In a trial with lucinactant, a synthetic peptide-containing surfactant completely devoid of animal-derived components, in infants managed with mechanical ventilation because of acute hypoxemic respiratory failure, oxygenation improved and the need for retreatment was significantly reduced, but other outcomes, such as ventilation time, did not change [54].
Treatment and respiratory support modes for neonates with respiratory distress syndrome
Published in Expert Opinion on Orphan Drugs, 2020
Theodore Dassios, Hemant Ambulkar, Anne Greenough
In neonates in a non-inferiority trial, Lucinactant was as effective in the treatment of RDS to Poractant [13]. Long-term respiratory outcomes, post-discharge rehospitalization rates, respiratory illnesses, and neurodevelopmental outcomes were similar in infants who received Lucinactant and those who received Colfosceril, Beractant, and Poractant [14].