The use of less invasive surfactant administration (LISA) in the United States with review of the literature

Abstract

Background The majority of extremely low gestational age neonates undergo intubation for surfactant therapy. Less invasive surfactant administration (LISA) uses a thin catheter inserted into the trachea to deliver the surfactant. During the procedure, the infant is breathing spontaneously while supported with continuous positive airway pressure. Although LISA is widely adapted in Europe and Australia, the rate of LISA use in the United States is unknown. Study design The aim of this study is to evaluate the use of LISA in the US. A web-based survey was distributed via SurveyMonkey to 2550 neonatologists from AAP's SoNPM mailing list. Results Of the 472 neonatologists who answered the survey, 15% used LISA either as a part of routine care (8%) or as part of research (7%). Conclusion Unlike several regions of Europe, LISA is not widely used in the US. Future studies should address ambiguities regarding infant selection, procedure training and "roadblocks" to its broader application.

Less invasive surfactant administration (LISA): chances and limitations

“…Surfactant administration via LISA is becoming more widely used in NICUs around the world 22–25. LISA has recently become an acknowledged alternative to the standard mode of surfactant delivery.…”

Survey of less Invasive Surfactant Administration in England, slow adoption and variable practice

“…A survey done in the Nordic countries shows an overall uptake of LISA of 32%; amongst non‐users 61% was due to lack of familiarity on how to perform the procedure, similar to our findings . LISA is not common practice in the United States, with a recent survey highlighting only 8% of neonatologists used LISA as part of routine care (472 responses out of 2550 contacted) . We think that it is important to highlight not only the importance of training, but also of gaining competence and experience, and it may not be appropriate for clinicians in SCBU settings to seek to implement LISA if it is going to be infrequently performed, or if babies are likely to be transferred (often ventilated) for persisting respiratory distress.…”

“…LISA is not common practice in the United States, with a recent survey highlighting only 8% of neonatologists used LISA as part of routine care (472 responses out of 2550 contacted) 16. We think that it is important to highlight not only the importance of training, but also of gaining competence and experience, and it may not be appropriate for clinicians in SCBU settings to seek to implement LISA if it is going to The expertise required to perform the procedure in extremely immature infants means that the UK appears to have some way to go before such an approach is broadly and safely available.…”

<p>Bronchopulmonary Dysplasia: An Overview</p>

“…88,89 With the known benefits of surfactant administration in the reduction of respiratory distress syndrome, and BPD, new approaches to its administration, less invasive surfactant administration (LISA) and minimally invasive surfactant therapy (MIST), are gaining clinical interest worldwide, and in some regions considered standard of care. 87,90,91 Kribs et al first described LISA, a method for delivering surfactant to infants on CPAP in 2007 with placement of a catheter through the vocal cords under direct laryngoscopy. 90,91 While this approach does not require intubation with an endotracheal tube, it does require laryngoscopy.…”

“…87,90,91 Kribs et al first described LISA, a method for delivering surfactant to infants on CPAP in 2007 with placement of a catheter through the vocal cords under direct laryngoscopy. 90,91 While this approach does not require intubation with an endotracheal tube, it does require laryngoscopy. MIST does not require laryngoscopy, or endotracheal intubation, and instead utilizes a laryngeal mask to direct a catheter and subsequently surfactant down the trachea, but without laryngoscopy and secure advancement past the vocal cords, there is no way to ensure the full dose enters the airways.…”