• Carmen Rey-Santano, Victoria E Mielgo, Miguel Angel Gomez-Solaetxe, Federico Bianco, Fabrizio Salomone, and Begoña Loureiro.
• Animal Research Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
• Crit. Care Med. 2020 Jun 1; 48 (6): e523-e531.

ObjectivesWe have setup for the first time a long-term (72 hr) respiratory distress syndrome model in spontaneously breathing surfactant-deficient newborn piglets to investigate the continuous positive airway pressure failure rate with nebulized poractant alfa compared with that with the intubation surfactant extubation technique or continuous positive airway pressure only.DesignProspective randomized animal study.SettingBiocruces-Bizkaia Health Research Institute Animal Facility.Subjects InterventionsEighteen newborn piglets (n = 6/group) with surfactant-deficient respiratory distress syndrome were randomized to three continuous positive airway pressure-ventilated groups: 1) nebulized surfactant (poractant alfa 400 mg/kg) via a customized investigational eFlow-Neos vibrating membrane nebulizer system, 2) bolus administration using the Intubation Surfactant Extubation method (200 mg/kg), or 3) continuous positive airway pressure alone.Measurements And Main ResultsPulmonary and hemodynamic variables were assessed at 6-hour intervals for 72 hours. Lung and brain histological analyses were performed. After bronchoalveolar lavages, piglets developed respiratory distress syndrome. Over the follow-up, both surfactant-treated groups had significantly better pulmonary outcomes than the continuous positive airway pressure alone group. Furthermore, unlike in the continuous positive airway pressure group, there were no cases of respiratory failure in either of the surfactant-treated groups.ConclusionsIn newborn piglets with respiratory distress syndrome, the nebulization of 400 mg/kg of poractant alfa using a customized investigational eFlow-Neos nebulizer was found to be safe and effective in reducing the risk of respiratory failure in the 72 hours after treatment.

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