Surfactant Administration Through Laryngeal or Supraglottic Airways

Abstract

Noninvasive ventilation is frequently used in the treatment of infants with respiratory distress syndrome. This practice is often effective in higher gestational age neonates, but can be difficult in those with lower gestational ages as surfactant deficiency can be severe. While noninvasive ventilation avoids the negative effects of intubation and ventilator-induced lung injury, failure of this mode of support does occur with relative frequency and is primarily caused by the poorly compliant, surfactant-deficient lung. Because of the potential problems associated with laryngoscopy and intubation, neonatologists have developed various methods to deliver surfactant in minimally invasive ways with the aim of improving the success of noninvasive ventilation. Methods of minimally invasive surfactant administration include various thin catheter techniques, aerosolization/nebulization, and the use of a laryngeal mask airway/supraglottic airway device. The clinician should recognize that currently the only US Food and Drug Administration–approved device to deliver surfactant is an endotracheal tube and all methods reviewed here are considered off-label use. This review will focus primarily on surfactant administration through laryngeal or supraglottic airways, providing a review of the history of this technique, animal and human trials, and comparison with other minimally invasive techniques. In addition, this review provides a step-by-step instruction guide on how to perform this procedure, including a multimedia tutorial to facilitate learning.

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

“…When there is a need to administer surfactant, the traditional approach has been to deliver exogenous surfactant through an endotracheal tube (ETT). However, less invasive methods, which may be considered “off label” use based on the country, are now widely being used around the world ( 11 ).…”

“…Proper placement is indicated by listening for bilateral breath sounds and, if available, color change on a carbon dioxide detector. A piece of tubing connected to the surfactant syringe is then placed into the lumen of the device to deliver the surfactant in aliquots just above the vocal cords ( 11 – 23 ). Figures 1 – 3 provide a guide on how to perform the SALSA technique.…”

“…The SALSA technique involves placement of a laryngeal mask or supraglottic airway into the posterior pharynx without the need for laryngoscopy. Liquid surfactant is then administered through the device ( 11 ). Surfactant can then be delivered in a variety of settings and skill levels through the ease and efficiency of this method.…”

Every breath counts: Lessons learned in developing a training NICU in Northern Tanzania

“…Importantly, we are careful to use warmed, humidified air and oxygen blenders while also performing meticulous nasal care and therapeutic infant positioning. For infants with severe respiratory distress, we pair this with judicious and timely administration of pulmonary surfactant (often administered through a laryngeal mask airway) ( 25 ). Additionally, we are elevating our reliance on kangaroo care, which reduces both hypothermia and rates of infection ( 26 ).…”

Implementation of Surfactant Administration through Laryngeal or Supraglottic Airways (SALSA): A Jordanian NICU’s Journey to Improve Surfactant Administration

“…The most recent method developed to minimize the negative effects and risks of airway manipulation is the SALSA technique. [ 18 ] A supraglottic airway device (SAD) has traditionally been used to obtain an airway when intubation has been difficult or unsuccessful and has been shown to be equivalent to intubation in efficacy for providing positive pressure ventilation [ 19 , 20 ]. With the SALSA technique, an SAD is used to administer surfactant.…”