Abstract
Nasal intermittent positive pressure ventilation (NIPPV) holds great potential as a primary ventilation support method for Respiratory Distress Syndrome (RDS). The use of NIPPV may also be of great value combined with minimally invasive surfactant delivery. Our aim was to implement an in vivo model of RDS, which can be managed with different non-invasive ventilation (NIV) strategies, including non-synchronized NIPPV, synchronized NIPPV (SNIPPV), and nasal continuous positive airway pressure (NCPAP). Forty-two surfactant-depleted adult rabbits were allocated in six different groups: three groups of animals were treated with only NIV for three hours (NIPPV, SNIPPV, and NCPAP groups), while three other groups were treated with surfactant (SF) followed by NIV (NIPPV+SF, SNIPPV+SF, and NCPAP+SF groups). Arterial gas exchange, ventilation indices, and dynamic compliance were assessed. Post-mortem the lungs were sampled for histological evaluation. Surfactant depletion was successfully achieved by repeated broncho-alveolar lavages (BALs). After BALs, all animals developed a moderate respiratory distress, which could not be reverted by merely applying NIV. Conversely, surfactant administration followed by NIV induced a rapid improvement of arterial oxygenation in all surfactant-treated groups. Breath synchronization was associated with a significantly better response in terms of gas exchange and dynamic compliance compared to non-synchronized NIPPV, showing also the lowest injury scores after histological assessment. The proposed in vivo model of surfactant deficiency was successfully managed with NCPAP, NIPPV, or SNIPPV; this model resembles a moderate respiratory distress and it is suitable for the preclinical testing of less invasive surfactant administration techniques.
Highlights
Preterm birth is characterized by a marked immaturity of all organ systems
Among SF-treated groups, the highest mean PaO2 values were observed for the synchronized NIPPV (SNIPPV)+SF group, which were significantly higher compared to Nasal intermittent positive pressure ventilation (NIPPV)+SF at any timepoint
The mean PaO2 values of the nasal continuous positive airway pressure (NCPAP)+SF group were higher than the values observed for NIPPV, reaching statistical significance at 60 and 120 minutes
Summary
The signs of lung immaturity manifest shortly after birth. The classic treatment against RDS entailed early tracheal intubation of the infants followed by the intratracheal instillation of exogenous surfactant and a variable period of intensive mechanical ventilation [5,6]. This approach has proved to be a life-saving therapy, the association between mechanical ventilation through an endotracheal tube and the incidence of chronic lung disease [7,8,9] led to the search of alternative, non-invasive ventilation (NIV) strategies
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