Surfactant Nebulization to Prevent Intubation in Preterm Infants: A Systematic Review and Meta-analysis

Gaertner, Vincent D.; Thomann, Janine; Bassler, Dirk; Rüegger, Christoph M.

doi:10.1542/peds.2021-052504

Cited by 26 publications

(17 citation statements)

References 44 publications

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“…As the difficulty increases, procedural experience is decreasing due to greater use of non-invasive ventilation, a reduction in working hours and significantly increased numbers of not just trainees but also consultants. [17][18][19][20] In response to this, many strategies have been employed to try and either reduce the need for intubation, [21][22][23] provide greater stability medically during the procedure 24 25 or improve education and therefore proficiency of the intubator. [26][27][28][29][30][31][32][33][34][35][36] Despite these strategies, intubation remains a problem and by comparison to adult studies our population show high rates of physiological instability and adverse events.…”

Section: Discussionmentioning

confidence: 99%

Nasal high-flow therapy to Optimise Stability during Intubation: the NOSI pilot trial

Foran

Moore

Chathasaigh

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveIn adult patients with acute respiratory failure, nasal high-flow (NHF) therapy at the time of intubation can decrease the duration of hypoxia. The objective of this pilot study was to calculate duration of peripheral oxygen saturation below 75% during single and multiple intubation attempts in order to inform development of a larger definitive trial.Design and settingThis double-blinded randomised controlled pilot trial was conducted at a single, tertiary neonatal centre from October 2020 to October 2021.ParticipantsInfants undergoing oral intubation in neonatal intensive care were included. Infants with upper airway anomalies were excluded.InterventionsInfants were randomly assigned (1:1) to have NHF 6 L/min, FiO21.0 or NHF 0 L/min (control) applied during intubation, stratified by gestational age (<34 weeks vs ≥34 weeks).Main outcome measuresThe primary outcome was duration of hypoxaemia of <75% up to the time of successful intubation,Results43 infants were enrolled (26 <34 weeks and 17 ≥34 weeks) with 50 intubation episodes. In infants <34 weeks’ gestation, median duration of SpO2of <75% was 29 s (0–126 s) vs 43 s (0–132 s) (p=0.78, intervention vs control). Median duration of SpO2 of<75% in babies ≥34 weeks’ gestation was 0 (0–32 s) vs 0 (0–20 s) (p=0.9, intervention vs control).ConclusionThis pilot study showed that it is feasible to provide NHF during intubation attempts. No significant differences were noted in duration of oxygen saturation of <75% between groups; however, this trial was not powered to detect a difference. A larger, higher-powered blinded study is warranted.

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Section: Discussionmentioning

confidence: 99%

Nasal high-flow therapy to Optimise Stability during Intubation: the NOSI pilot trial

Foran

Moore

Chathasaigh

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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“…(26) Minimally invasive surfactant administration techniques such as thin catheter surfactant administration (LISA/MIST), surfactant administration through laryngeal or supraglottic airways (SALSA) and aerosolized surfactant, has made surfactant administration safer yet as e cacious when compared to traditional surfactant administration through an endotracheal tube. (17,(27)(28)(29)(30)(31) This calls for the early identi cation of those patient who will eventually fail CPAP and require late surfactant. We think RSS can be an important predictor to identify such infants for early rescue surfactant therapy through the various methods of minimally invasive surfactant administration.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Severity Score during the first three hours of life as a predictor for CPAP failure and need for late surfactant administration

Zapata

Becker

Lasarev³

et al. 2022

Preprint

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Background Preterm infants often develop CPAP failure. These infants miss the advantages of early rescue surfactant therapy. In this study, we evaluate the utility of Respiratory Severity Score (RSS) during the first three hours of life (HOL) as a predictor for CPAP failure. Methods We conducted a post-hoc analysis of patients who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression were used to assess whether the RSS summary measures were associated with the odds of surfactant administration. Results Study involved 146 infants. Sixty-four infants (45%) received surfactant within the first 72 hours. Administration of surfactant was associated with the mean RSS (p < 0.01) and the linear trend (p < 0.01). Conclusion We demonstrated that RSS during the first three HOL can predict CPAP failure and need for surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies.

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“…In a systematic review of ~1,095 infants, the aerosolized surfactant group had a significantly reduced intubation rate compared with the standard care group at 72 h after birth. The intubation rate was lower in infants > 28 weeks' gestation with no differences in neonatal morbidities or mortality identified ( 67 ).…”

Section: Aerosolized Surfactant Administrationmentioning

confidence: 99%

Surfactant Administration Through Laryngeal or Supraglottic Airways (SALSA): A Viable Method for Low-Income and Middle-Income Countries

et al. 2022

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Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. A skilled health care provider is needed to perform this procedure. In lower-income and middle-income countries (LMICs), healthcare resources are often limited, leading to increased mortality of premature infants, many of whom would benefit from surfactant administration. Therefore, having a simplified procedure for delivery of surfactant without the need for advanced skills could be life-saving, potentially diminish gaps in care, and help ensure more equitable global neonatal survival rates. Modifications to the standard approach of surfactant administration have been put into practice and these include: INtubation-SURfactant-Extubation (INSURE), thin catheter surfactant administration (TCA), aerosolized surfactant, and surfactant administration through laryngeal or supraglottic airways (SALSA). Although there is a need for larger studies to evaluate the comparative effectiveness of these newer methods, these methods are being embraced by the global community and being implemented in various settings throughout the world. Because the SALSA technique does not require laryngoscopy, a provider skilled in laryngoscopy is not required for the procedure. Therefore, because of the ease of use and safety profile, the SALSA technique should be strongly considered as a viable method of delivering surfactant in LMICs.

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Surfactant Nebulization to Prevent Intubation in Preterm Infants: A Systematic Review and Meta-analysis

Cited by 26 publications

References 44 publications

Nasal high-flow therapy to Optimise Stability during Intubation: the NOSI pilot trial

Nasal high-flow therapy to Optimise Stability during Intubation: the NOSI pilot trial

Respiratory Severity Score during the first three hours of life as a predictor for CPAP failure and need for late surfactant administration

Surfactant Administration Through Laryngeal or Supraglottic Airways (SALSA): A Viable Method for Low-Income and Middle-Income Countries

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