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Updated: Jun 25, 2026
06:22
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
Published on: April 7, 2021
Assist control volume guarantee ventilation during surfactant administration.
K I Wheeler1, P G Davis, C O F Kamlin
1Neonatal Services, The Royal Women's Hospital (RWH), Melbourne, Australia. kevin.wheeler@thewomens.org.au
Archives of Disease in Childhood. Fetal and Neonatal Edition
|February 6, 2009
Summary
Surfactant administration during assist control volume guarantee (AC/VG) ventilation commonly causes endotracheal gas flow obstruction in preterm infants. Peak inflation pressures (PIP) increase and may limit tidal volume delivery, requiring careful ventilator management.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Respiratory distress syndrome (RDS) is common in preterm infants.
- Surfactant therapy is a standard treatment for RDS.
- Assist control volume guarantee (AC/VG) ventilation is frequently used in neonatal intensive care units.
Purpose of the Study:
- To evaluate changes in ventilator parameters in preterm infants receiving surfactant therapy during AC/VG ventilation.
- To assess the impact of surfactant administration on endotracheal gas flow and pressure dynamics.
Main Methods:
- A prospective study involving 22 preterm infants (gestation ≤ 32 weeks) receiving surfactant.
- Ventilator parameters, including pressures, flow, and tidal volume waveforms, were recorded using a Dräger Babylog 8000 plus.
- Measurements were compared before and after surfactant administration.
Main Results:
- Complete endotracheal gas flow obstruction occurred in 21 of 22 infants post-surfactant.
- Peak inflation pressure (PIP) increased by a median of 8 cm H2O and remained elevated for 30-60 minutes.
- Inspired oxygen concentration decreased significantly within 5 minutes; tidal volume delivery was often below target due to maximum PIP (Pmax) settings.
Conclusions:
- Endotracheal gas flow obstruction is a frequent complication of surfactant delivery during AC/VG ventilation.
- Elevated PIPs and potential tidal volume restriction by Pmax settings necessitate close monitoring and adjustment of ventilator parameters.
- Optimizing ventilator settings is crucial to ensure adequate gas exchange and lung protection in preterm infants receiving surfactant.
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