Neonatal Division, Maternity and Children Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia.
Neonatal Division, Department of Pediatrics, Western University, London, Canada.
Am J Perinatol. 2022 Oct;39(13):1433-1440. doi: 10.1055/s-0041-1722953. Epub 2021 Jan 31.
Laryngeal mask airway (LMA) has emerged as an alternative surfactant delivery method. The effectiveness of this method for the delivery of surfactant is uncertain. A meta-analysis of randomized control trials (RCTs) comparing LMA with standard methods of surfactant delivery for the outcomes of surfactant dose repetition, oxygen requirement, mechanical ventilation, intubation, mortality, bronchopulmonary dysplasia (BPD), and pneumothorax.
Systematic review and meta-analysis of RCTs. Homogeneity between studies was analyzed by using I statistics. Risk ratio or mean difference of outcomes was assessed from random effects models. Subgroup analyses were conducted when necessary. Data sources are as follows: Ovid Medline, Embase, and the Cochrane Central Register of Controlled trials from inception till December 2018, bibliographies of identified reviews and trial registries for ongoing studies. RCTs comparing short-term respiratory outcomes in neonates with respiratory distress syndrome who were administered surfactant through an LMA versus standard method of care.
Six RCTs were identified, enrolling a total of 357 infants. Administering surfactant via LMA was associated with decreased FiO requirement (mean difference = 1.82 (95% confidence interval [CI]: -6.01-9.66), decreased intubation (risk ratio [RR] = 0.17; 95% CI: 0.05-0.57), and decreased mechanical ventilation (RR = 0.44; 95% CI: 0.31-0.61). There were no significant differences between groups for death, BPD, or pneumothorax.
LMA might be an effective alternative method of surfactant delivery; however, further high-quality RCTs with larger sample size and including extreme preterm infants are needed to establish LMA as an alternative technique for surfactant delivery.
· Pulmonary surfactants reduce mortality and pulmonary air leaks in newborns with respiratory distress syndrome.. · Preterm lungs are at risk of volutrauma by mechanical ventilation; laryngoscopy is still traumatic.. · Surfactant administration via LMA to avoid mechanical ventilation and intubation might be feasible..
喉罩气道（LMA）已成为替代表面活性剂输送方法。这种方法输送表面活性剂的效果尚不确定。对比较 LMA 与标准表面活性剂输送方法的随机对照试验（RCT）进行荟萃分析，以评估表面活性剂剂量重复、氧需求、机械通气、插管、死亡率、支气管肺发育不良（BPD）和气胸的结果。
对 RCT 的系统评价和荟萃分析。通过 I 统计分析评估研究间的同质性。使用随机效应模型评估结局的风险比或均数差值。必要时进行亚组分析。数据来源如下：Ovid Medline、Embase 和 Cochrane 对照试验中心注册库，自成立至 2018 年 12 月，已确定的综述参考文献和正在进行的研究试验登记处。比较通过 LMA 与标准治疗方法给予表面活性剂的呼吸窘迫综合征新生儿短期呼吸结局的 RCT。
共确定了 6 项 RCT，共纳入 357 例婴儿。通过 LMA 给予表面活性剂与 FiO 需求降低相关（均数差=1.82（95%置信区间[CI]：-6.01-9.66））、插管减少（风险比[RR]=0.17；95% CI：0.05-0.57）和机械通气减少（RR=0.44；95% CI：0.31-0.61）。两组之间死亡率、BPD 或气胸无显著差异。
LMA 可能是一种有效的表面活性剂输送替代方法；然而，需要进一步开展高质量、大样本量的 RCT，并纳入极早产儿，以确立 LMA 作为表面活性剂输送的替代技术。
·肺表面活性剂可降低呼吸窘迫综合征新生儿的死亡率和肺空气漏。·早产儿的肺有发生呼吸机所致肺损伤的风险；喉镜检查仍然具有创伤性。·通过 LMA 给予表面活性剂以避免机械通气和插管可能是可行的。
