Can the laryngeal mask airway be used to give surfactant in preterm infants?

• Published in: Archives of disease in childhood Vol. 105; no. 6; pp. 601 - 603
• Main Authors: Smee, Natalie J, O'Shea, Joyce E
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.06.2020
• Subjects: Acidosis; Airway management; Babies; Body Weight; Bradycardia; Cardiac arrhythmia; Catheters; Clinical Diagnosis; Continuous positive airway pressure; Control Groups; Failure; Hypoxia; Infants; Information Seeking; Intubation; Laryngoscopy; Mechanical ventilation; Morbidity; Oxygen requirement; Peer Acceptance; Pregnancy; Premature babies; Premature birth; Respiratory distress syndrome; Respiratory therapy; Respiratory tract; Search Strategies; Success; Surfactants; Ventilation; Ventilators; Young Children; neonatology; evidence based medicine
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-318562

At 6 hours of age, the infant is on nasal continuous positive airway pressure (CPAP) but has a rising oxygen requirement exceeding 40%, respiratory acidosis and a chest X-ray consistent with respiratory distress syndrome (RDS). Trial stopped early due to extremely low enrolment CPAP, continuous positive airway pressure; LMA, laryngeal mask airway; MV, mechanical ventilation; RCT, randomised controlled trial; RDS, respiratory distress syndrome ; RR, relative risk. Commentary RDS caused by surfactant deficiency remains a significant cause of morbidity and mortality in the preterm infant.1 Strategies for surfactant replacement include early prophylactic following delivery room intubation or more recently selective where infants are stabilised on CPAP and then given surfactant selectively if they clinically go on to develop RDS. Surfactant administration by this route is associated with at least the same or greater incidence of transient bradycardia and hypoxia as that seen during intubation and surfactant administration.3 Roberts et al demonstrated that the LMA insertion can be taught easily and placed quickly without the need for laryngoscopy or visualising the cords and with no adverse events or bradycardia.5 They reported a 69% success rate on first attempt to place the LMA and a reduced number of overall attempts were required for successful placement of the LMA compared with the ETT.