Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University and School of Medicine, Virginia Commonwealth University, P.O. Box 980276, Richmond, VA 23298-0276, USA.
Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University and School of Medicine, Virginia Commonwealth University, P.O. Box 980276, Richmond, VA 23298-0276, USA.
Paediatr Respir Rev. 2022 Sep;43:38-43. doi: 10.1016/j.prrv.2021.10.002. Epub 2021 Nov 3.
The provision of exogenous surfactant to premature infants with respiratory distress syndrome has revolutionized the way we care for these patients, significantly improving survival and decreasing morbidity. Currently, the Intubate-SURfactant-Extubate (INSURE) to non-invasive ventilation method remains the standard method for surfactant delivery in the United States. However, the INSURE method requires intubation via direct visualization with a laryngoscope and possible need for sedation. Both carry significant risk to the patients, prompting the development of less invasive ways of safely and efficaciously providing surfactant to newborn infants. The present article reviews and describes the benefits and limitations of several of these alternative methods, including Less Invasive Surfactant Administration (LISA), Minimally Invasive Surfactant Therapy (MIST), via aerosolization, laryngeal mask airway (LMA), and direct nasopharyngeal deposition, focusing on assessment of clinical benefits and the level/risk of invasiveness.
外源性表面活性剂的提供给患有呼吸窘迫综合征的早产儿带来了革命性的变化，显著提高了存活率，降低了发病率。目前，经气管内插管-表面活性剂-拔管（INSURE）至无创通气方法仍然是美国表面活性剂输送的标准方法。然而，INSURE 方法需要通过喉镜直接可视化进行插管，并可能需要镇静。这两者都给患者带来了重大风险，促使人们开发出更微创的方法，以安全有效地向新生儿提供表面活性剂。本文回顾并描述了几种替代方法的益处和局限性，包括经气管内插管给予表面活性剂（LISA）、经气管内插管给予表面活性剂（MIST）、经雾化给予表面活性剂、喉罩气道（LMA）和直接鼻咽沉积，重点评估临床益处和侵袭性水平/风险。
