Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review

Abstract

Surfactant is an effective treatment for respiratory distress syndrome, being particularly important for infants in whom continuous positive airway pressure (CPAP) provides insufficient support. Supraglottic airway devices present an attractive option for surfactant delivery, particularly as an alternative to methods dependent on direct laryngoscopy, a procedural skill that is both difficult to learn and in which to maintain competence. Published studies provide encouraging data that surfactant administration by supraglottic airway device can be performed with a high rate of success and may reduce the need for subsequent intubation compared with either continued CPAP or surfactant administration via endotracheal tube. However, existing randomised controlled trials (RCTs) are heterogeneous in design and include just over 350 infants in total. To date, all RCT evidence has been generated in tertiary units, whereas the greatest potential for benefit from the use of these devices is likely to be in non-tertiary settings. Future research should investigate choice and utility of device in addition to safety and effectiveness of procedure. Importantly, studies conducted in non-tertiary settings should evaluate feasibility, meaningful clinical outcomes and the impact that this approach might have on infants and their families. Supraglottic airway devices may represent a simple and effective mode of surfactant administration that can be widely used by a variety of clinicians. However, further well-designed RCTs are required to determine their role, safety and effectiveness in both tertiary and non-tertiary settings before introduction into routine clinical practice.

Surfactant Replacement Therapy: What’s the New Future?

“…Serios adverse events observed during surfactant administration via LMA include physiological instability during the procedure (prolonged bradycardia and/or desaturation), need for emergent intubation, tension pneumothorax, and PH. 93 However, many studies have reported no serious side effects during and after intervention. 86,88,[90][91][92][93] Supraglottic airway devices are suitable alternatives for surfactant administration, eliminating the need for direct laryngoscopy, and many studies have shown encouraging results.…”

“…93 However, many studies have reported no serious side effects during and after intervention. 86,88,[90][91][92][93] Supraglottic airway devices are suitable alternatives for surfactant administration, eliminating the need for direct laryngoscopy, and many studies have shown encouraging results. However, the studies till date have heterogenous study design and a small number of subjects.…”

Feasibility and safety of surfactant administration via laryngeal mask airway as first-line therapy for a select newborn population: results of a standardized clinical protocol

“…The possible bene ts of utilizing SAD over LISA are ease of placement and minimization of potential complications of intubation including oxygen desaturation, bradycardia, changes in blood pressure that may increase the risk of intracranial hemorrhage, and trauma to the oropharyngeal tissue. 2,4,[6][7][8] In contrast, LISA requires at least the same skills as intubation and carries similar risks including transient hypoxemia and bradycardia with possible changes in cerebral perfusion rates. [6][7][8][9][10][11][12][13][14] During LISA, positive pressure ventilation (PPV) can be potentially avoided whereas with SAD, PPV is still required to instill the surfactant.…”

“…During both methods, infants can remain on a non-invasive ventilation (NIV) mode. [1][2][3][4][5] Currently available sizes of SAD devices limit the application of this procedure to birth weights > 1000g, with the smallest infant reported having a birth weight of 1050g. 2,16 Unfortunately, prior randomized controlled trials (RCTs) on surfactant delivery by SAD have been heterogeneous in entry criteria, ranges of gestational age and birth weight, different premedication protocols and used various SAD devices.…”

Lung Deposition of Surfactant Delivered via a Dedicated Laryngeal Mask Airway in Piglets

“…Besides nebulization [13,14], another proposed mode for surfactant delivery in preterm infants is the use of a laryngeal mask airway (LMA) [15,16], a supraglottic airway device. This technique's advantage is reducing invasiveness by precluding laryngoscopy during catheter positioning and requiring less training for proper placement than laryngoscopy and endotracheal intubation.…”