“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.