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

IMPORTANCE: Episodes of severe airway obstruction (SAO) are reported during surfactant administration. OBJECTIVE: To evaluate adherence to and impact of a surfactant protocol on adverse events. METHODS: An evidence-based protocol for surfactant administration was developed (2011), implemented (2012) and re-implemented (2014), including three major steps: lung recruitment, manual bagging, and bolus instillation. Three epochs were evaluated: E(0) (2010), E(1) (2015) and E(2) (2018). Adherence was defined as compliance with all steps. Adverse events such as hypoxia (<80%) and severe airway obstruction (SAO) were investigated. RESULTS: 197 infants (246 administrations) were included: E(0) 81 (110), E(1) 52 (63), and E(2) 64 (73). Adherence improved from 49% (E(1)) to 67% (E(2)). Full adherence to protocol significantly decreased SAO from 26% to 1.25% (E(2); p < 0.005) and hypoxia/bradycardia events (5 to 0% E(2); p < 0.005), without any side effects. CONCLUSIONS: Adherence to a surfactant administration protocol improved over time and significantly decreased important adverse events.