Laryngeal Mask Airway for Surfactant Administration in a Newborn Animal Model

Abstract

Premature infants are subjected to adverse effects of intubation to benefit from surfactant. We hypothesized that administration of surfactant through a laryngeal mask airway (LMA) is as effective as administration through an endotracheal tube (ETT) and that time and physiologic changes during instrumentation will be less in the LMA group. This study is a randomized, controlled trial using newborn pigs. Lung injury was induced via surfactant washout. Animals were randomized into groups: 1) LMA placed, no surfactant administered (control; n = 8); 2) surfactant via an LMA (LMA group; n = 8); and 3) surfactant via an ETT (ETT group; n = 8). We demonstrated that partial pressure of oxygen in arterial blood (Pao2) levels of the LMA and ETT groups were not statistically different. Time for successful placement of LMA was 19 ± 1 s versus ETT 123 ± 35 s (mean ± SEM); number of attempts for successful LMA placement was 1.1 (1-2) versus ETT 1.9 (1-7) [mean (range)]. Administration of surfactant via an LMA compared with an ETT resulted in similar improvements in oxygenation. Placement of the device required less time and fewer attempts. These data suggest that further study in human neonates is justified. If proven effective, some infants with respiratory distress may be able to receive surfactant while avoiding intubation.

Surfactant Administration via Thin Catheter During Spontaneous Breathing: Randomized Controlled Trial

“…Reports on surfactant application via laryngeal mask are interesting but refer to only a small number of patients. 22,23 Administration of surfactant via a thin catheter during spontaneous breathing with CPAP has been used since 2001. In this method, generally the catheter is placed with Magill forceps into the trachea under direct laryngoscopy and surfactant is applied over a period of 1 to 3 minutes.…”

The use of bougie‐guided insertion of a laryngeal mask airway device in neonatal piglets after unexpected complications

“…This is also the case in adult (Goldmann and others 2005) and neonatal (Roberts and others 2010) pigs. In rabbits, known to present narrow mouth opening and poor visualisation of the larynx inlet, LM could be placed in 8 to 12-fold less time than endotracheal intubation was achieved, especially for anaesthetists with little experience (Smith and others 2004).…”

“…The use of a laryngeal mask (LM) is an appropriate alternative to endotracheal intubation, providing an airtight seal around the laryngeal inlet with the option to ventilate the animal if necessary (Wemyss-Holden and others 1999, Fulkerson and Gustafson 2007). Its use in neonate swine has been described once by Roberts and others (2010) as safe, uncomplicated and rapid. Moreover, the LM has been used to achieve ventilation in human patients in whom tracheal intubation or ventilation through facemask has failed (Asai 1996); it thus has a potential role in patients with difficult airways.…”

AARC Clinical Practice Guideline. Surfactant Replacement Therapy: 2013

“…In an animal study comparing ETT to LMA surfactant delivery, it was reported that surfactant delivery could be accomplished sooner in the LMA group with equivalent efficacy. 85 7 In animal studies, distribution of intratracheally instilled surfactant has been largely determined by gravity, and unaffected by the position of the chest. 89 Therefore, leaving the chest in a horizontal position may result in the most even distribution of surfactant to the lungs.…”