Jahmani Tamara, Miller Michael R, da Silva Orlando, Bhattacharya Soume
Department of Pediatrics, Western University, London, ON N6A 3K7, Canada.
Children's Health Research Institute, 800 Commissioners Road East, London, ON N6C 2V5, Canada.
Biomedicines. 2024 Mar 9;12(3):618. doi: 10.3390/biomedicines12030618.
Minimally invasive surfactant therapy (MIST) has emerged as a preferred method of surfactant delivery. Pioneers of this technique have described the use of direct laryngoscopy (DL) for MIST. With the increasing application of video laryngoscopy (VL) for neonatal airway management, it is speculated that MIST techniques can be adapted for use with VL.
To compare procedural success, operator ease of use, and complication of MIST using VL vs. MIST using DL.
This was a retrospective, observational cohort study conducted at a tertiary-level neonatal intensive care unit after obtaining ethical approval. We included neonates who received MIST between 1 October 2020 and 31 October 2022. Baseline demographic characteristics, along with procedural data, were collected. Primary outcome measures included the overall procedural success rate, the need for multiple attempts, and the total number of attempts. Secondary outcome measures included the occurrence of adverse events, the need for a second dose of surfactant, and the need for intubation within 7 days of the procedure. Means and SDs, independent -tests, frequencies, and chi-square were used as appropriate. -values < 0.05 were considered statistically significant.
Of the 79 neonates included, 37 neonates received MIST via VL, while 42 received MIST via DL. The median gestational age was lower in the VL group at 29.0 weeks vs. 30.5 weeks ( = 0.011) in the DL group. The median birthweight in the VL group was 1260 g, IQR (1080, 1690), which was significantly lower than the DL group, which was 1575 g, IQR (1220, 2251), = 0.028. Purpose-built catheter use was higher in the DL group. The overall procedural success was similar between groups. The need for multiple attempts was lower with VL in comparison to DL [4 (11%) vs. 13 (31%); = 0.034)] at the univariate level but not significant at multivariate analysis ( = 0.131). Procedural complications, the need for a second dose of surfactant, the need for mechanical ventilation post-MIST, and operator ease of use were similar. User comments emphasized the value of VL in providing real-time visual information to confirm catheter placement and guide operators/trainees.
Overall, in our cohort, despite VL being a more recently adapted technology used more in smaller, sicker, and more premature neonates, procedural success, complications, and operator ease of use for MIST using VL and DL were comparable. Our findings show the successful application of VL for MIST and suggest procedural advantages that might facilitate universal adoption.
微创表面活性剂治疗（MIST）已成为表面活性剂给药的首选方法。该技术的先驱者描述了在MIST中使用直接喉镜检查（DL）。随着视频喉镜（VL）在新生儿气道管理中的应用越来越多，推测MIST技术可适用于VL。
比较使用VL的MIST与使用DL的MIST的操作成功率、操作者易用性和并发症。
这是一项在获得伦理批准后于三级新生儿重症监护病房进行的回顾性观察队列研究。我们纳入了2020年10月1日至2022年10月31日期间接受MIST的新生儿。收集了基线人口统计学特征以及操作数据。主要结局指标包括总体操作成功率、多次尝试的必要性和尝试总数。次要结局指标包括不良事件的发生、第二剂表面活性剂的需求以及操作后7天内插管的需求。根据情况使用均值和标准差、独立t检验、频率和卡方检验。P值<0.05被认为具有统计学意义。
在纳入的79例新生儿中，37例通过VL接受MIST，42例通过DL接受MIST。VL组的中位胎龄较低，为29.0周，而DL组为30.5周（P = 0.011）。VL组的中位出生体重为1260 g，四分位数间距（IQR）为（1080，1690），显著低于DL组的1575 g，IQR为（1220，2251），P = 0.028。DL组专用导管的使用率更高。两组之间的总体操作成功率相似。在单变量水平上，与DL相比，VL多次尝试的必要性更低[4例（11%）对13例（31%）；P = 0.034]，但在多变量分析中不显著（P = 0.131）。操作并发症、第二剂表面活性剂的需求、MIST后机械通气的需求以及操作者易用性相似。用户评论强调了VL在提供实时视觉信息以确认导管位置和指导操作者/培训人员方面的价值。
总体而言，在我们的队列中，尽管VL是一种较新采用的技术，更多用于更小、病情更重和更早产的新生儿，但使用VL和DL进行MIST的操作成功率、并发症和操作者易用性相当。我们的研究结果显示了VL在MIST中的成功应用，并表明了可能有助于普遍采用的操作优势。
