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. 2021 Jan;41(1):17-23.
doi: 10.1038/s41372-020-00846-1. Epub 2020 Oct 3.

"Optimal surfactant delivery protocol using the bovine lipid extract surfactant: a quality improvement study"

Alexandra Germain  1 , Nina Nouraeyan  2 , Martine Claveau  3 , Marisa Leone  4 , Guilherme Sant'Anna  5
Affiliations

"Optimal surfactant delivery protocol using the bovine lipid extract surfactant: a quality improvement study"

Alexandra Germain et al. J Perinatol. 2021 Jan.

Abstract

Importance: Episodes of severe airway obstruction (SAO) are reported during surfactant administration.

Objective: To evaluate adherence to and impact of a surfactant protocol on adverse events.

Methods: An evidence-based protocol for surfactant administration was developed (2011), implemented (2012) and re-implemented (2014), including three major steps: lung recruitment, manual bagging, and bolus instillation. Three epochs were evaluated: E0 (2010), E1 (2015) and E2 (2018). Adherence was defined as compliance with all steps. Adverse events such as hypoxia (<80%) and severe airway obstruction (SAO) were investigated.

Results: 197 infants (246 administrations) were included: E0 81 (110), E1 52 (63), and E2 64 (73). Adherence improved from 49% (E1) to 67% (E2). Full adherence to protocol significantly decreased SAO from 26% to 1.25% (E2; p < 0.005) and hypoxia/bradycardia events (5 to 0% E2; p < 0.005), without any side effects.

Conclusions: Adherence to a surfactant administration protocol improved over time and significantly decreased important adverse events.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Surfactant protocol implementation and re-implementation timeline.
The interventions performed are described for each year. The final QI evaluation was done using the years of 2010, 2015 and 2018.
Fig. 2
Fig. 2. Flow diagram of the population.
SAE = surfactant administration events.
Fig. 3
Fig. 3. Severe airways obstruction events over time.
SAO = Severe airway obstruction. Each point represents the number of SAO events for the periods of January–March, April–June, July–September and October–December; for all Epochs of the study. The box shows the number of surfactant administration events and percentage of SAO for each specific period. In Epochs 1 and 2 only surfactant administration events with full adherence to the protocol were included.
See this image and copyright information in PMC

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