Preliminary evaluation of a new technique of minimally invasive surfactant therapy

Dargaville, Peter A.; Aiyappan, Ajit; Cornelius, Anita; Williams, Christopher S.; Paoli, Antonio G De

doi:10.1136/adc.2010.192518

Cited by 184 publications

(167 citation statements)

References 35 publications

(36 reference statements)

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“…As a result, the minimally invasive surfactant administration (MIST) technique has been proposed as an alternative, in which, following direct laryngoscopy, the surfactant is slowly administered through a thin tracheal catheter to infants capable of spontaneous breathing and supported by CPAP. This technique does not require the administration of sedatives or the use of positive pressure ventilation and causes less damage to the airways and is well-tolerated by tinier infants (15,16).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

et al. 2017

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Background: The present study was conducted to investigate and compare the effectiveness of the minimally invasive surfactant therapy (MIST) and the INSURE technique (Intubation, Surfactant administration, and extubation) in spontaneously breathing preterm infants. Methods: Preterm infants (28-34 weeks of gestation) born with respiratory distress syndrome between April 2013 and February 2014 were randomly selected to receive 200 mg/kg of surfactant (Curosurf) using either MIST or INSURE techniques. In the MIST group, surfactant was instilled via a thin tracheal catheter (5-f) that was then removed. In the INSURE group, the infants were first intubated, administered surfactant through passing a feeding tube through the endotracheal tube, and then extubated after 30 seconds of positive pressure ventilation. Nasal CPAP for respiratory support continued in both groups after performing the procedures. The amounts of supplemental oxygen required, intensive care requirements, and outcomes were compared between the two groups. Results: The present study examined 27 infants in the MIST group and 26 in the INSURE group. The amount of oxygen required by

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Section: Introductionmentioning

confidence: 99%

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

et al. 2017

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“…17 Alternatively, a semirigid vascular catheter can be guided through the vocal cords without a trochar or forceps. 18 Laryngeal mask airways have been used for surfactant administration in a study of premature infants between 880 and 2520 g, 76 and a recent RCT has confirmed that this technique achieves effective surfactant delivery. 77 Aerosolized surfactant would be the least invasive and probably most desirable way of administering surfactant.…”

mentioning

confidence: 99%

“…13,37 In this regard, nCPAP with surfactant treatment during spontaneous breathing is a promising option because it allows to combine avoidance of eMV with early surfactant administration. [17][18][19]36 It is worth noting that 33% to 83% of study patients in the noninvasive treatment groups needed eMV at some point during their clinical course (Table 1). It is possible that these patients still benefited with regard to BPD reduction because eMV was avoided during the postnatal transition period when their lungs were particularly vulnerable.…”

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confidence: 99%

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

2013

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Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis abstract BACKGROUND AND OBJECTIVE: Mechanical ventilation via an endotra-cheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants ,30 weeks' gestational age (GA). METHODS: In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants ,30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6. RESULTS: We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage.

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“…This has led to a search for alternative strategies of providing exogenous surfactant using noninvasive or minimally invasive techniques which essentially avoid the use of an endotracheal tube; collectively labelled as 'minimally invasive surfactant therapy' (MIST) [Gupta and Donn, 2012]. These include pharyngeal instillation of surfactants [Kattwinkel et al 2004], administration via laryngeal mask airway [Trevisanuto et al 2005] and administration via a thin endotracheal catheter/feeding tube [Dargaville et al 2011]. The protocols for using these techniques are described in the individual publications but these are observational studies and their safety and efficacy is still not validated in controlled trials, and hence not generalizable to other units.…”

Section: Exogenous Surfactant Replacement Therapymentioning

confidence: 99%

Adjunctive drug therapies for treatment of respiratory diseases in the newborn: based on evidence or habit?

Sinha

Tin

2014

Ther Adv Respir Dis

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Abstract:Respiratory distress syndrome is a disease of prematurity and is caused by a relative deficiency of endogenous surfactant production. Respiratory distress syndrome is the most common cause of mortality and morbidity in the newborn population and the standard of care is to provide exogenous surfactant therapy. This saves lives and reduces respiratory complications but, despite treatment, a significant proportion of these infants go onto develop chronic lung disease, the severest form of which is bronchopulmonary dysplasia. Once developed, this is a multisystem disease and treatment is mostly supportive by using various therapeutic adjuncts. Some of these have been proven to be safe and effective in large randomized, controlled trials but similar evidence for other drugs is lacking. The aim of this paper is to provide an overview and critically appraise the available scientific evidence for or against their use in routine practice.

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Preliminary evaluation of a new technique of minimally invasive surfactant therapy

Abstract: Surfactant can be effectively delivered via a vascular catheter, and this method of MIST deserves further investigation.

Cited by 184 publications

References 35 publications

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

Adjunctive drug therapies for treatment of respiratory diseases in the newborn: based on evidence or habit?

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