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Randomized Controlled Trial
. 2024 Mar;27(1):87-96.
doi: 10.1007/s40477-023-00820-5. Epub 2023 Sep 3.

Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration

Maurizio Radicioni  1 , Serena Pennoni  2 , Ambra Fantauzzi  3 , Vittorio Bini  4 , Piergiorgio Camerini  3
Affiliations
Randomized Controlled Trial

Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration

Maurizio Radicioni et al. J Ultrasound. 2024 Mar.

Abstract

Purpose: Concerns remain on different alveolar deposition of surfactant between LISA and INSURE methods. Ultrasound evaluation of diaphragm kinetics may provide clinical evidence on this issue, as indirect representation of the respiratory system compliance.

Methods: This was a prospective-observational pilot study. The inclusion criterion was CPAP-supported infants ≤ 32 weeks with RDS receiving surfactant via minimally invasive technique. 52 patients randomized for surfactant administration via LISA or INSURE methods were enrolled. Right diaphragm (RD) global mean peak velocity (MPV) by Pulsed-Wave Tissue Doppler Imaging (PTDI) was recorded before and two hours after surfactant administration with simultaneous measurements of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio). Mechanical ventilation ≤ 72 h from birth represented treatment failure.

Results: LISA infants had significantly higher gestational age (p = 0.029) and birth weight (p = 0.030) with lower CRIB-II scores (p = 0.030) than INSURE infants. LISA infants showed higher median MPV at baseline RD-PTDI US assessment (p = 0.024), but post-surfactant median MPV and other the investigated variables were similar at the adjusted analysis for gestational age and sedation. 8/52 (15%) infants who failed treatment had a significantly lower SF ratio (p = 0.002) and higher median MPV at RD-PTDI US (p = 0.004) after surfactant administration, despite the higher CPAP support level before (p = 0.007) and after (p = 0.001) surfactant administration. A full course of antenatal steroids was protective against mechanical ventilation (p = 0.038).

Conclusions: Different minimally invasive surfactant administration techniques do not appear to influence diaphragm kinetics evaluated by RD-PTDI US.

Keywords: CPAP; Diaphragm ultrasound; INSURE; LISA; Preterm infant.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Fig. 1
Fig. 1
Right diaphragm pulsed wave tissue Doppler imaging. A B-mode imaging of the right hemidiaphragm. The white arrow shows the right diaphragmatic line beneath the hepatic vein confluence chosen as the anatomic landmark. B Pulsed wave tissue Doppler spectral trace of the right hemidiaphragm motion
See this image and copyright information in PMC

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