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

Area of Science:

• Neonatal Respiratory Care
• Pediatric Pulmonology
• Evidence-Based Medicine

Background:

• Surfactant administration in infants can lead to severe airway obstruction (SAO).
• Existing practices for surfactant delivery may not consistently prevent adverse events.
• A standardized approach is needed to improve safety during this critical procedure.

Purpose of the Study:

• To assess adherence to a newly developed surfactant administration protocol.
• To evaluate the impact of this protocol on the incidence of adverse events, including SAO and hypoxia.
• To determine if protocol implementation leads to improved patient outcomes.

Main Methods:

• An evidence-based surfactant administration protocol involving lung recruitment, manual bagging, and bolus instillation was developed and implemented in three phases.
• Data were collected from 197 infants across three epochs (2010, 2015, 2018) to assess protocol adherence and adverse events.
• Adherence was measured by compliance with all protocol steps; adverse events like hypoxia and SAO were recorded and analyzed.

Main Results:

• Protocol adherence increased from 49% in the first re-implementation phase to 67% in the second.
• Full adherence to the protocol significantly reduced SAO from 26% to 1.25%.
• Hypoxia and bradycardia events decreased from 5% to 0% with full protocol adherence, with no reported side effects.

Conclusions:

• Improved adherence to the surfactant administration protocol was observed over time.
• The protocol significantly decreased the occurrence of severe airway obstruction and other adverse events.
• Implementing this evidence-based protocol enhances the safety of surfactant administration in neonates.