Am J Perinatol 2013; 30(03): 201-206
DOI: 10.1055/s-0032-1323592
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Administration of Rescue Surfactant by Laryngeal Mask Airway: Lessons from a Pilot Trial

Joshua T. Attridge
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Corrine Stewart
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
George J. Stukenborg
2   Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
,
John Kattwinkel
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
› Author Affiliations
Further Information

Publication History

20 October 2011

06 April 2012

Publication Date:
14 August 2012 (online)

Abstract

Objectives To determine if surfactant can be effectively administered to larger preterm babies by laryngeal mask airway (LMA), reducing the need for supplemental oxygen.

Study Design Enrollment criteria: birth weight > 1200 g, < 72 hours old, treated with nasal continuous positive airway pressure (nCPAP) for respiratory distress syndrome, with fraction of inspired oxygen (Fio 2) requirement between 0.30 and 0.60. Subjects were randomized either to receive 3 mL/kg calfactant by LMA (experimental) followed by LMA removal back to CPAP, or continued on nCPAP (control). After intervention, both groups remained on nCPAP with Fio 2 adjusted to maintain O2 saturations at 88 to 95%.

Results A total of 26 patients (13 per group) were randomized, and 24 completed the study (11 experimental, 13 control). Groups were similar with respect to gender, mode of delivery, estimated gestational age, birth weight, and oxygen and pressure requirements at enrollment. Infants enrolled in the treatment group had an abrupt and sustained decrease in oxygen requirement after LMA surfactant therapy.

Conclusion This pilot study demonstrates that surfactant can be delivered by LMA, which leads to a significant decrease in supplemental oxygen requirement. Larger controlled trials in low-resource settings may show this technique to be valuable in clinical situations where direct laryngoscopy and intubation are difficult or where resources for mechanical ventilation are limited.

 
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