Abstract
Background
In preterm infants, InSurE (Intubation–Surfactant–Extubation) and LISA (less invasive surfactant administration) techniques allow for exogenous surfactant administration while reducing lung injury associated with mechanical ventilation. We compared the acute pulmonary response and lung deposition of surfactant by LISA and InSurE in surfactant-depleted adult rabbits.
Methods
Twenty-six spontaneously breathing surfactant-depleted adult rabbits (6–7 weeks old) with moderate RDS and managed with nasal continuous positive airway pressure were randomized to 3 groups: (1) 200 mg/kg of surfactant by InSurE; (2) 200 mg/kg of surfactant by LISA; (3) no surfactant treatment (Control). Gas exchange and lung mechanics were monitored for 180 min. After that, surfactant lung deposition and distribution were evaluated monitoring disaturated-phosphatidylcholine (DSPC) and surfactant protein C (SP-C), respectively.
Results
No signs of recovery were found in the untreated animals. After InSurE, oxygenation improved more rapidly compared to LISA. However, at 180’ LISA and InSurE showed comparable outcomes in terms of gas exchange, ventilation parameters, and lung mechanics. Neither DSPC in the alveolar pool nor SP-C signal distributions in a frontal lung section were significantly different between InSurE and LISA groups.
Conclusions
In an acute setting, LISA demonstrated efficacy and surfactant lung delivery similar to that of InSurE in surfactant-depleted adult rabbits.
Impact
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Although LISA technique is gaining popularity, there are still several questions to address. This is the first study comparing LISA and InSurE in terms of gas exchange, ventilation parameters, and lung mechanics as well as surfactant deposition and distribution.
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In our animal study, three hours post-treatment, LISA method seems to be as effective as InSurE and showed similar surfactant lung delivery.
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Our findings provide some clarifications on a fair comparison between LISA and InSurE techniques, particularly in terms of surfactant delivery. They should reassure some of the concerns raised by the clinical community on LISA adoption in neonatal units.
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Acknowledgements
This study was supported by Chiesi Farmaceutici SpA. The company contributed to the study design but had no influence in the analysis and interpretation of data and in writing the manuscript.
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F.R.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—original draft, writing—review and editing; I.B.: conceptualization, data curation, formal analysis, investigation, methodology, validation, writing—original draft, writing—review and editing; P.A.M.L.: conceptualization, data curation, formal analysis, investigation, methodology, validation; F.S.: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—original draft, writing—review and editing; C. Casiraghi: data curation, formal analysis, investigation, methodology, validation; A.M.: data curation, formal analysis, investigation, methodology, validation; M. Storti: data curation, formal analysis, investigation, methodology, validation; C. Catozzi: conceptualization, data curation, formal analysis, investigation, methodology, validation; L.T.: data curation, validation, writing—review and editing; R.Z.: data curation, formal analysis, investigation, methodology, validation, writing—review and editing; P.F.: data curation, formal analysis, investigation, methodology, validation, writing—review and editing; X.M.: data curation, formal analysis, writing—review and editing; M. Simonato: data curation, formal analysis, investigation, methodology, validation, writing—review and editing; P.C.: data curation, methodology, validation, writing—review and editing; V.C.: conceptualization, project administration, supervision, validation, writing—review and editing; G.L.: conceptualization, data curation, project administration, supervision, validation, visualization, writing—original draft, writing—review and editing.
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F.R., F.S., C. Casiraghi, C. Catozzi, and L.T. are Chiesi Farmaceutici SpA employees. X.M. acts as Chiesi Farmaceutici SpA scientific consultant.
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Ricci, F., Bresesti, I., LaVerde, P.A.M. et al. Surfactant lung delivery with LISA and InSurE in adult rabbits with respiratory distress. Pediatr Res 90, 576–583 (2021). https://doi.org/10.1038/s41390-020-01324-2
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DOI: https://doi.org/10.1038/s41390-020-01324-2
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