The INSURE method in preterm infants of less than 30 weeks' gestation

Dani, Carlo; Corsini, Iuri; Bertini, Giovanna; Fontanelli, Giulia; Pratesi, Simone; Rubaltelli, Firmino F.

doi:10.3109/14767050903572174

Cited by 61 publications

(63 citation statements)

References 23 publications

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“…The reported failure rates of INSURE strategies vary between 30-50% [11,[19][20][21][22][23][24][25][26] and are mainly due to differences in the population studied and different definition of INSURE failure. However, other factors may influence the results, such as the clinical criteria used to select the patients, different CPAP modes, surfactant types, study design, and even the use of different definitions for INSURE strategy.…”

Section: Discussionmentioning

confidence: 99%

“…CPAP was shown to distends alveoli, maintain the patency of the airways during expiration, prevent surfactant depletion and the prevention of alveolar collapse. The INSURE strategy reduces the need and duration of MV, length of oxygen therapy, the need of additional surfactant doses, and length of hospitalization in the neonatal intensive care unit [17][18][19][20]. A decreased rate of BPD was reported compared to classical surfactant administration plus MV strategy [16].…”

Section: Introductionmentioning

confidence: 99%

“…A decreased rate of BPD was reported compared to classical surfactant administration plus MV strategy [16]. However, the reported failure rates vary between 9-50%, [11,[18][19][20][21][22][23][24][25][26][27] restricting the universal adaptation of the beneficial effects the strategy.…”

Section: Introductionmentioning

confidence: 99%

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Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

Ognean

Stoicescu

Boantă

et al. 2016

The Journal of Critical Care Medicine

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Introduction: Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

Ognean

Stoicescu

Boantă

et al. 2016

The Journal of Critical Care Medicine

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“…It is therefore unlikely that the services and care delivered during the clinical trials differs significantly from that practiced in the United States at present. Notably, new respiratory support strategies, such as endotracheal intubation for surfactant administration with early extubation and continuous positive airway pressure (CPAP) initiation (InSurE method) 26,27 or early initiation of CPAP, 28,29 are now used in some care centers in addition to those used in clinical trials, and these new strategies may have health benefits not evaluated in this study. However, these support strategies are not defined as part of the current standard of care and are themselves experimental.…”

Section: Discussionmentioning

confidence: 99%

“…The objectives of this study were to estimate the economic impact and health care resource utilization of reintubation and conventional MV strategies in surviving preterm infants weighing 600 to 1250 grams treated with surfactant for the prevention of RDS. Other strategies, such as endotracheal intubation for surfactant administration with early extubation and continuous positive airway pressure (CPAP) initiation (InSurE method) 26,27 and early initiation of CPAP were not assessed. 28,29 …”

Section: Introductionmentioning

confidence: 99%

A Pharmacoeconomic Analysis of In-Hospital Costs Resulting from Reintubation in Preterm Infants Treated with Lucinactant, Beractant, or Poractant Alfa

Guardia

Moya

Sinha

et al. 2012

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Reintubation and subsequent mechanical ventilation (MV) in preterm infants after surfactant replacement therapy are associated with excess morbidity and mortality and likely increase in-hospital costs. Specific surfactant therapy selection for prevention of respiratory distress syndrome (RDS) in preterm infants receiving conventional MV may impact not only clinical outcomes but also pharmacoeconomic outcomes. METHODS We conducted a pharmacoeconomic analysis of the impact of surfactant selection and reintubation and subsequent MV of preterm infants on health care resource utilization. Rates of reintubation and duration of MV after reintubation were determined from 1546 preterm infants enrolled in two surfactant trials comparing lucinactant to beractant and poractant alfa. Hospital costs were obtained from a 2010 US database from 1564 preterm infants with RDS, with a direct cost of $2637 per day for MV in the neonatal intensive care unit. Cost of reintubation by study and treatment was estimated as the incidence of reintubation multiplied by days on MV therapy after reintubation multiplied by cost per day for direct MV costs, standardized per 100 surfactant-treated infants. RESULTS There were no differences between studies or treatment groups in the overall extubation rate. Average MV duration following reintubation was similar between groups in both trials; however, reintubation rates were significantly lower (p<0 05) for infants treated with lucinactant than for those receiving beractant or poractant alfa. The observed differences in reintubation rates resulted in a projected cost saving of $160,013 to $252,203 per 100 infants treated with lucinactant versus animal-derived surfactants. CONCLUSIONS In this analysis, higher reintubation rates following successful extubation in preterm infants receiving animal-derived surfactant preparations significantly increased estimated in-hospital costs, primarily due to excess costs associated with MV. This analysis suggests that surfactant selection may have a significant pharmacoeconomic impact on cost of patient care. Additional cost assessment of potential reduction in reintubation-associated morbidity is warranted.

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Current Trends in Neonatal Tracheostomy

Isaiah

Moyer

Pereira

2016

JAMA Otolaryngol Head Neck Surg

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The INSURE method in preterm infants of less than 30 weeks' gestation

Abstract: The INSURE method can be applied to the majority of extremely preterm infants and is followed by a high percentage of success.

Cited by 61 publications

References 23 publications

Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who Are the Best Candidates?

A Pharmacoeconomic Analysis of In-Hospital Costs Resulting from Reintubation in Preterm Infants Treated with Lucinactant, Beractant, or Poractant Alfa

Current Trends in Neonatal Tracheostomy

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