Roberto Raschetti1, Nadya Yousef2, Giulia Vigo2, Gianluigi Marseglia3, Roberta Centorrino2, Rafik Ben-Ammar2, Shivani Shankar-Aguilera2, Daniele De Luca4. 1. Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, South Paris University Hospitals, AP-HP, Paris, France; Medical School, South Paris-Saclay University, Paris, France; School of Pediatrics, University of Pavia, Pavia, Italy. 2. Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, South Paris University Hospitals, AP-HP, Paris, France. 3. School of Pediatrics, University of Pavia, Pavia, Italy. 4. Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, South Paris University Hospitals, AP-HP, Paris, France; Medical School, South Paris-Saclay University, Paris, France. Electronic address: dm.deluca@icloud.com.
Abstract
OBJECTIVE: To improve time of surfactant administration with a surfactant replacement protocol based on semiquantitative lung ultrasound score (LUS) thresholds. STUDY DESIGN: Quality improvement (QI), prospective, before-after, pilot study. In a 6-month period surfactant replacement was based only on inspired oxygen fraction (FiO2) thresholds. In the second 6-month period, surfactant was given when either the FiO2 or LUS exceeded the limits. The main QI measures were the proportion of neonates receiving surfactant within the first 3 hours of life and maximal FiO2 reached before surfactant replacement. Secondary QI measures were the duration of respiratory support and ventilator-free days. Data were also collected for 1 year after the study to verify sustainability. RESULTS: Echography-guided Surfactant THERapy (ESTHER) increased the proportion of neonates receiving surfactant within the first 3 hours of life (71.4%-90%; P < .0001) and reduced the maximal FiO2 reached before surfactant replacement (0.33 [0.26-0.5]) vs 0.4 [0.4-0.55]; P = .005). The global need for surfactant did not significantly change. ESTHER also resulted in a significant decrease in duration of invasive ventilation and ventilator-free days. CONCLUSIONS: ESTHER improved the timeliness of surfactant administration and secondary QI indicators related to surfactant replacement.
OBJECTIVE: To improve time of surfactant administration with a surfactant replacement protocol based on semiquantitative lung ultrasound score (LUS) thresholds. STUDY DESIGN: Quality improvement (QI), prospective, before-after, pilot study. In a 6-month period surfactant replacement was based only on inspired oxygen fraction (FiO2) thresholds. In the second 6-month period, surfactant was given when either the FiO2 or LUS exceeded the limits. The main QI measures were the proportion of neonates receiving surfactant within the first 3 hours of life and maximal FiO2 reached before surfactant replacement. Secondary QI measures were the duration of respiratory support and ventilator-free days. Data were also collected for 1 year after the study to verify sustainability. RESULTS: Echography-guided Surfactant THERapy (ESTHER) increased the proportion of neonates receiving surfactant within the first 3 hours of life (71.4%-90%; P < .0001) and reduced the maximal FiO2 reached before surfactant replacement (0.33 [0.26-0.5]) vs 0.4 [0.4-0.55]; P = .005). The global need for surfactant did not significantly change. ESTHER also resulted in a significant decrease in duration of invasive ventilation and ventilator-free days. CONCLUSIONS: ESTHER improved the timeliness of surfactant administration and secondary QI indicators related to surfactant replacement.
Authors: Fiorella Migliaro; Serena Salomè; Iuri Corsini; Daniele De Luca; Letizia Capasso; Diego Gragnaniello; Francesco Raimondi Journal: Early Hum Dev Date: 2020-09-10 Impact factor: 2.079
Authors: Javier Rodriguez-Fanjul; I Jordan; M Balaguer; A Batista-Muñoz; M Ramon; S Bobillo-Perez Journal: Eur J Pediatr Date: 2020-07-24 Impact factor: 3.183
Authors: Yogen Singh; Cecile Tissot; María V Fraga; Nadya Yousef; Rafael Gonzalez Cortes; Jorge Lopez; Joan Sanchez-de-Toledo; Joe Brierley; Juan Mayordomo Colunga; Dusan Raffaj; Eduardo Da Cruz; Philippe Durand; Peter Kenderessy; Hans-Joerg Lang; Akira Nishisaki; Martin C Kneyber; Pierre Tissieres; Thomas W Conlon; Daniele De Luca Journal: Crit Care Date: 2020-02-24 Impact factor: 9.097