A survey of minimally invasive surfactant therapy in Canada

Abstract

Introduction Minimally invasive surfactant therapy (MIST) can be used to treat neonatal respiratory distress syndrome in neonatal intensive care units (NICUs). Clinical and institutional variances in MIST utilization persist globally with little published research regarding MIST utilization in Canada. Therefore, the objective of this study was to survey MIST utilization in NICUs in Canada. Methods An online survey was emailed to the 33 participating centres of Canadian Neonatal Network TM (CNN) Evidence-based Practice for Improving Quality (EPIQ) Lung Health Group (LHG). Site demographics and surfactant therapy procedural details were categorically collected. Free text and multiple-choice questions were utilized to capture perceived barriers and individual preferences for MIST use. Results Twenty-eight of 33 participating members of the CNN EPIQ-LHG completed the survey between April 2021 and October 2021 (85%); 17/28 (61%) respondents reported ongoing MIST utilization at their center. Most centers that used MIST techniques administered bovine lipid extract surfactant (68%), commonly using angiocatheters (47%) and purpose-built catheters (41%). MIST was widely used for patients at 26–33 weeks gestational age (88%). Nine centres had never used MIST (32%), and 3 indicated a plan to implement MIST within the next 2 years. Common barriers to MIST use included lack of consensus amongst clinicians (78%), lack of training (56%), and lack of experience with MIST (56%). Conclusion While MIST is being increasingly used in Canadian NICUs, universal use is yet to be seen. Clinician inexperience and lack of consensus, formal training, and local guidelines contribute to underutilization of MIST. Training workshops, country-wide data collection, and uniform operating protocols are needed to standardize practice.

Purpose built catheters for minimally invasive surfactant therapy: Experience from a Canadian tertiary level neonatal intensive care unit

“…A recent survey of MIST use in Canada reported that 47% of centers using MIST utilize Angiocatheter to deliver surfactant, whereas 41% use purpose-built catheters. 20 Some centers still report the use of feeding tubes. Among the centers that do not use MIST, 22% cited the lack of availability of purpose-built catheters as the reason for the non-implementation of MIST.…”

Application of Video Laryngoscopy for Minimally Invasive Surfactant Therapy: A Retrospective Comparative Cohort Study

“…MIST procedures that have been adopted in various countries often demonstrate practice variations, such as varying types of catheters, types of surfactants, choice of premedications, etc. [ 6 , 8 , 9 ]. The type of laryngoscope used to conduct MIST is now emerging to be another such procedural variation.…”

“…With the increasing application of VL for neonatal airway management, it is speculated that MIST techniques can be easily adapted for use with VL. In a Canadian survey, 47% of the neonatal intensive care units (NICUs) in Canada used VL for MIST procedures [ 8 ]. Recently, a quality improvement initiative showed the safety and efficacy of VL use in LISA [ 3 ].…”