Severe airway obstruction during surfactant administration using a standardized protocol: a prospective, observational study

Objective:the objective of this study was to evaluate the occurrence of adverse effects during surfactant delivery, using a standardized protocol for administration and management of complications.study design:the protocol was developed, implemented and used for 6 months. vital signs and ventilatory parameters were prospectively recorded during the procedure. infants were classified into three groups, based on the occurrence and severity of complications: no, minor or major.result:a total of 39 infants received surfactant and 19 presented some complication: 11 minor and 8 major. six of the major complications were episodes of severe airway obstruction (sao) and five occurred in extreme low birth weight (elbw) infants that had more severe lung disease before surfactant delivery. two cases of persistent pulmonary hypertension occurred in infants with birth weight>1000 g.conclusion:this study identified a high rate of sao and provides data to support changes in the protocol, which should include faster and more robust increases in positive inspiratory pressures in elbw infants presenting with sao.