Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

Abstract

Background: The laryngeal mask airway (LMA^TM, Laryngeal Mask Co. Ltd, Jersey, UK) is a supraglottic device used to administer positive pressure ventilation (PPV) in adults, pediatric and neonatal patients. Objectives: To avoid endotracheal intubation, we evaluated the feasibility and practicality of administering surfactant via the LMA^TM in preterm infants with respiratory distress syndrome (RDS). Methods: Infants less than 72 h old with a gestational age of ≤35 weeks and a birth weight of >800 g, treated with nasal continuous positive airway pressure (CPAP, 5 cm H₂O) for RDS were eligible for inclusion in the study if the arterial-to-alveolar oxygen tension ratio (a/APO₂) was <0.20 over a period of >60 min. Results: Eight preterm infants, median gestational age 31 (range 28–35) weeks; birth weight 1,700 (880–2,520) g, treated with nasal CPAP for RDS were enrolled. Three hours after surfactant instillation, the mean a/APO₂ was significantly increased (0.13 ± 0.04 to 0.34 ± 0.11; p < 0.01) without complications. Conclusions: The LMA^TM may be a useful and noninvasive conduit for the administration of surfactant therapy. A large randomized comparative clinical trial will be required to confirm the efficacy of this technique.