Administering surfactant without intubation – what does the laryngeal mask offer us?

Dargaville, Peter A.

doi:10.1016/j.jped.2017.02.001

Cited by 4 publications

(1 citation statement)

References 24 publications

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“…33 37 42 The validity of this method is questionable, as it presumes that all aspirated liquid is surfactant and that all surfactant deposited in the stomach will be aspirated, neither of which is likely to be correct. 47 Surfactant reflux is observed with other modes of administration including INSURE 34 and LISA, 7 8 with treatment success achieved even if a proportion of the administered dose does not reach the lungs.…”

Section: Surfactant Dosing and Deliverymentioning

confidence: 99%

Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review

Roberts

Manley

O’Shea

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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Surfactant is an effective treatment for respiratory distress syndrome, being particularly important for infants in whom continuous positive airway pressure (CPAP) provides insufficient support. Supraglottic airway devices present an attractive option for surfactant delivery, particularly as an alternative to methods dependent on direct laryngoscopy, a procedural skill that is both difficult to learn and in which to maintain competence. Published studies provide encouraging data that surfactant administration by supraglottic airway device can be performed with a high rate of success and may reduce the need for subsequent intubation compared with either continued CPAP or surfactant administration via endotracheal tube. However, existing randomised controlled trials (RCTs) are heterogeneous in design and include just over 350 infants in total. To date, all RCT evidence has been generated in tertiary units, whereas the greatest potential for benefit from the use of these devices is likely to be in non-tertiary settings. Future research should investigate choice and utility of device in addition to safety and effectiveness of procedure. Importantly, studies conducted in non-tertiary settings should evaluate feasibility, meaningful clinical outcomes and the impact that this approach might have on infants and their families. Supraglottic airway devices may represent a simple and effective mode of surfactant administration that can be widely used by a variety of clinicians. However, further well-designed RCTs are required to determine their role, safety and effectiveness in both tertiary and non-tertiary settings before introduction into routine clinical practice.

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Section: Surfactant Dosing and Deliverymentioning

confidence: 99%

Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review

Roberts

Manley

O’Shea

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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Newer Strategies for Surfactant Delivery

Dargaville¹

2019

The Newborn Lung

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Survey of less Invasive Surfactant Administration in England, slow adoption and variable practice

et al. 2019

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Aim National survey to evaluate the uptake of Less Invasive Surfactant Administration (LISA) in neonatal units across England. Methods A web‐based survey was sent out by email to all 150 neonatal units in England. It consisted of questions regarding indications for LISA, the practicalities of the procedure and reasons for not using this technique. Results The response rate was 96% (144/150 units). Only 11% of units are using LISA, but majority (78%) would consider implementing LISA on their unit. 56% would also consider LISA on delivery suite. Challenges identified are having a guideline and staff training. 61% of units have set the target population ≥27 weeks. On sub‐analysis, for tertiary units, the trend for LISA is ≥26 weeks. The median FiO2 threshold for LISA is 0.3 (IQR 0.3‐0.4) in less than 28 weeks gestational age (GA), and 0.4 in higher gestations. The most common suggestion for premedication is fentanyl (32%). Conclusion The uptake of LISA in England is low comparing to the rest of Europe. Even though many units are considering implementing LISA, there is lack of training and national guidelines. There is urgent need for standardisation of practice and clear indications for LISA.

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Administering surfactant without intubation – what does the laryngeal mask offer us?

Cited by 4 publications

References 24 publications

Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review

Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review

Newer Strategies for Surfactant Delivery

Survey of less Invasive Surfactant Administration in England, slow adoption and variable practice

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