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 (