A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates
Objective: To compare the short‐term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. Methods: Preterm infants (28–35 weeks of gestational age), weighing 1 kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, wit...
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| Format: | Article |
| Language: | Portuguese |
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Brazilian Society of Pediatrics
2017-07-01
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| Series: | Jornal de Pediatria (Versão em Português) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S225555361730006X |
| _version_ | 1797991519826739200 |
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| author | Rosilu F. Barbosa Ana C. Simões e Silva Yerkes P. Silva |
| author_facet | Rosilu F. Barbosa Ana C. Simões e Silva Yerkes P. Silva |
| author_sort | Rosilu F. Barbosa |
| collection | DOAJ |
| description | Objective: To compare the short‐term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube.
Methods: Preterm infants (28–35 weeks of gestational age), weighing 1 kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2) ≥ 0.40 to maintain oxygen saturation 91–95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2 ≤ 0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24 h, MV requirement, and presence of surfactant in gastric content.
Results: Forty‐eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p = 0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups.
Conclusions: Surfactant administration by LMA showed short‐term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results. |
| first_indexed | 2024-04-11T08:53:23Z |
| format | Article |
| id | doaj.art-e361c04ddfb9444bba4df4d670259b8a |
| institution | Directory Open Access Journal |
| issn | 2255-5536 |
| language | Portuguese |
| last_indexed | 2024-04-11T08:53:23Z |
| publishDate | 2017-07-01 |
| publisher | Brazilian Society of Pediatrics |
| record_format | Article |
| series | Jornal de Pediatria (Versão em Português) |
| spelling | doaj.art-e361c04ddfb9444bba4df4d670259b8a2022-12-22T04:33:25ZporBrazilian Society of PediatricsJornal de Pediatria (Versão em Português)2255-55362017-07-0193434335010.1016/j.jpedp.2017.02.003A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonatesRosilu F. Barbosa0Ana C. Simões e Silva1Yerkes P. Silva2Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, BrasilObjective: To compare the short‐term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. Methods: Preterm infants (28–35 weeks of gestational age), weighing 1 kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2) ≥ 0.40 to maintain oxygen saturation 91–95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2 ≤ 0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24 h, MV requirement, and presence of surfactant in gastric content. Results: Forty‐eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p = 0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups. Conclusions: Surfactant administration by LMA showed short‐term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results.http://www.sciencedirect.com/science/article/pii/S225555361730006XLaryngeal mask airwayPreterm infantPulmonary surfactant |
| spellingShingle | Rosilu F. Barbosa Ana C. Simões e Silva Yerkes P. Silva A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates Jornal de Pediatria (Versão em Português) Laryngeal mask airway Preterm infant Pulmonary surfactant |
| title | A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates |
| title_full | A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates |
| title_fullStr | A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates |
| title_full_unstemmed | A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates |
| title_short | A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates |
| title_sort | randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates |
| topic | Laryngeal mask airway Preterm infant Pulmonary surfactant |
| url | http://www.sciencedirect.com/science/article/pii/S225555361730006X |
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