Abstract
Objective Surfactant delivery via a thin endotracheal catheter during spontaneous breathing;
a technique called minimally invasive surfactant therapy (MIST) is an alternative
to intubation and surfactant administration. Procedural details among different centers
vary, with marked differences in the choice of catheter to instill surfactant. Studies
report use of feeding catheters, multiaccess suction catheters, vascular catheters,
and more recently custom-built catheters for this purpose. The impact of choice of
catheter on procedural success and procedural adverse effects has not been reported.
Our present study compares the procedural success and adverse effects of MIST using
a semirigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multiaccess
catheter (MAC).
Study Design This was a retrospective review of prospectively collected data at a tertiary care
neonatal intensive care unit in Southwestern Ontario. All neonates who received surfactant
via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant
baseline characteristics and data on procedural details (premedication, type of catheter,
etc.) were collected. The procedural success, number of attempts, and adverse effects
between neonates who received MIST via MAC and 16G Angiocath was compared by using
Chi-square test or Fisher's test as appropriate. A p-value of less that 0.05 was considered significant.
Results A total of 139 neonates received surfactant via MIST method during the study period.
Moreover, 93 neonates received the surfactant via MAC, while 46 received it via Angiocath.
The baseline demographic characteristics in the two group were similar. A higher proportion
of neonates in Angiocath group received Atropine (100 vs. 76%, p = 0.002) and Fentanyl (98 vs. 36%, p < 0.001) than the MAC group.
The procedural success was 91% in the Angiocath group and 89% in the MAC group (p > 0.99). Multiple attempts were needed in 24% of neonates in the Angiocath group
and 37% in the MAC group (p = 0.158). More episodes of desaturations were noted in the Angiocath group (89%)
than the MAC group (69%; p = 0.012). Other rates of common adverse effects were similar between the two groups.
On exploratory analysis fentanyl use held significant association with less success,
more desaturation, apneic episodes, and need of positive pressure ventilation /intubation.
Conclusion The overall procedural success of MIST is similar in both catheter groups. The proportion
of neonates requiring multiple attempts was lower with the Angiocath, though difference
was not statistically significant. Desaturation episodes were seen more frequently
in the Angiocath group, which was related to higher use of procedural sedation in
this group.
Key Points
-
MIST is emerging as a less invasive method of surfactant delivery that has proven
clinical benefits.
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Considerable, procedural variation is reported, particularly regarding choice of catheter.
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Our present study compares the procedural success and adverse effects of MIST using
a semirigid vascular catheter (16G Angiocath-Hobart method) versus a flexible MAC.
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High and comparable procedural success was seen in both groups.
Keywords
neonates - surfactant - minimally invasive - multiaccess catheter - angiocath
