BOVINE LIPID EXTRACT SURFACTANT (BLES®) ADMINISTRATION USING A MINIMALLY INVASIVE APPROACH
Bibliographic record
Abstract
Abstract BACKGROUND There is growing evidence that surfactant delivery via a thin endotracheal catheter during spontaneous breathing; a technique called minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant administration. The majority of studies evaluating the MIST technique have utilized a higher concentration; lower volume surfactant at a dose of 2.5ml/kg. Little evidence is available describing the feasibility of administering a lower concentration, larger volume surfactant at a dose of 5ml/kg utilizing the MIST technique. OBJECTIVES To describe the feasibility of utilizing Bovine Lipid Extract Surfactant (BLES®) with the MIST technique within a single tertiary centre after a change in practice. DESIGN/METHODS A guideline for surfactant administration (BLES® – 5 ml/kg) using the MIST technique was developed in our centre in 2016. Infants with a birth weight ≥ 1000 g and ≥28 weeks gestation were deemed eligible candidates for this technique if they developed RDS and met criteria for surfactant administration (FiO2 requirement greater than 40% on nasal continuous positive airway pressure (NCPAP) and were clinically well apart from respiratory distress. Surfactant was administered via a thin catheter (KimVent® Multi-Access Catheter) which was inserted into the trachea using Magill forceps, while the baby continued to breathe spontaneously on NCPAP. Depth of catheter insertion was estimated using 6 cm + weight in kg. Surfactant was instilled into the trachea over 1–3 minutes and the delivery was timed to coincide with inspiration. Administration of sucrose was recommended and of atropine was optional prior to laryngoscopy for insertion of the endotracheal catheter. RESULTS Since implementation of the new guidelines, a total of 22 infants received surfactant by the MIST method. The mean gestational age was 32 ± 2.6 weeks and mean birth weight was 1972 ± 788g. Five infants (22.7%) had transient bradycardia and desaturations during the procedure. Five infants (22.7%) required intubation post MIST procedure at variable times (range 6–29 hours), 3 infants (14%) for increasing oxygen requirements and a second dose of surfactant and 2 (9%) infants for hypercapnia and poor respiratory drive. Twenty infants (90%) were successfully weaned to 21% oxygen on NCPAP post procedure at a median duration of 0.5 (range 0.01–29) hours. CONCLUSION The delivery of BLES® using the MIST technique for RDS was overall well tolerated by the patients and shown to be an effective alternative to more invasive methods.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".