Introducing Less-Invasive Surfactant Administration into a Level IV NICU: A Quality Improvement Initiative.

Steven M Conlon,Julie Bodie,Rita M Ryan,Tara Glenn,Allison Osborne,Jaime Marasch

doi:10.3390/children8070580

Abstract

Less-invasive surfactant administration (LISA), a newer technique of delivering surfactant via a thin catheter, avoids mechanical ventilation. LISA has been widely adopted in Europe but less so in the US. Our goal was to increase the percentage of surfactant delivered via LISA from 0% to 51% by 12/2020. Project planning and literature review started 12/2019, and included a standardized equipment kit and simulation training sessions. We began Plan–Do–Study–Act (PDSA) cycles in 6/2020. Initial exclusions for LISA were gestational age (GA) <28 weeks (w) or ≥36 w, intubation in the delivery room, or PCO2 >70 if known; GA exclusion is now <25 w. From 6 to 12/2020, 97 patients received surfactant, 35 (36%) via LISA. When non-LISA-eligible patients were excluded, 35/42 (83%) received LISA successfully. There were only 2/37 patients for whom LISA was not able to be performed. Three LISA infants required mechanical ventilation in the first week of life. Sedation remained an initial challenge but improved when sucrose was used routinely. LISA was safely and successfully introduced in our NICU.

Highlights

Less-invasive surfactant administration (LISA) is a technique to administer surfactant via a thin catheter
Surfactant administration is associated with lower risk of air leak syndromes, reduced need for patent ductus arteriosus (PDA) treatment and bronchopulmonary dysplasia [1]
Even brief positive pressure ventilation (PPV), such as the intubation–surfactant–extubation (InSurE) technique, can lead to an inflammatory cascade that is associated with bronchopulmonary dysplasia (BPD) [2,3]

Summary

Introduction

Less-invasive surfactant administration (LISA) is a technique to administer surfactant via a thin catheter. Surfactant administration is associated with lower risk of air leak syndromes, reduced need for patent ductus arteriosus (PDA) treatment and bronchopulmonary dysplasia [1]. Most surfactant administration techniques require mechanical ventilation or the use of positive pressure ventilation (PPV). Aggressive weaning of ventilator settings and trials of continuous positive airway pressure (CPAP) prior to intubation have been used to avoid the drawbacks of mechanical ventilation [4]. This leads to a binary decision tree in which an infant is either exposed to early surfactant with barotrauma or surfactant is delayed following a trial of CPAP [5]

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Conclusion