Lung Deposition of Surfactant Delivered via a Dedicated Laryngeal Mask Airway in Piglets.

Anders Nord,Daniele Trevisanuto,Fabrizio Salomone,Doris Cunha-Goncalves,Massimo Micaglio,Valeria Perez-De-Sa,Rikard Linnér,Marta Lombardini,Francesca Ricci,Federico Bianco

doi:10.3390/pharmaceutics13111858

Anders Nord, Daniele Trevisanuto + Show 8 more

Open Access

https://doi.org/10.3390/pharmaceutics13111858

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Journal: Pharmaceutics	Publication Date: Nov 4, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: Lund University, University of Padua, Chiesi (Italy)

Abstract

It is unknown if the lung deposition of surfactant administered via a catheter placed through a laryngeal mask airway (LMA) is equivalent to that obtained by bolus instillation through an endotracheal tube. We compare the lung deposition of surfactant delivered via two types of LMA with the standard technique of endotracheal instillation. 25 newborn piglets on continuous positive airway pressure support (CPAP) were randomized into three groups: 1—LMA-camera (integrated camera and catheter channel; catheter tip below vocal cords), 2—LMA-standard (no camera, no channel; catheter tip above the glottis), 3—InSurE (Intubation, Surfactant administration, Extubation; catheter tip below end of endotracheal tube). All animals received 100 mg·kg−1 of poractant alfa mixed with 99mTechnetium-nanocolloid. Surfactant deposition was measured by gamma scintigraphy as a percentage of the administered dose. The median (range) total lung surfactant deposition was 68% (10–85), 41% (5–88), and 88% (67–92) in LMA-camera, LMA-standard, and InSurE, respectively, which was higher (p < 0.05) in the latter. The deposition in the stomach and nasopharynx was higher with the LMA-standard. The surfactant deposition via an LMA was lower than that obtained with InSurE. Although not statistically significant, introducing the catheter below the vocal cords under visual control with an integrated camera improved surfactant LMA delivery by 65%.

Highlights

Respiratory distress syndrome (RDS) [1] is the most common cause of respiratory insufficiency in preterm infants
In line with Bonadies et al.’s [37] observations, we demonstrated that even when an experienced operator blindly introduced the laryngeal mask airway (LMA), a failure to obtain an accurate position of the device occurred in 50% of the attempts using the standard control procedures for verifying proper placement
The success rate for the correct placement of a surfactant delivery catheter beyond the vocal cords via an LMA improved from 12% (3 of 25) to 89% (8 of 9) by incorporating a catheter channel and a camera into an LMA

Summary

Introduction

Respiratory distress syndrome (RDS) [1] is the most common cause of respiratory insufficiency in preterm infants. Even though mortality rates and the frequency of pneumothorax decreased with the introduction of surfactant treatment, the incidence of bronchopulmonary dysplasia (BPD) remains unchanged [2]. To avoid or shorten the exposure to mechanical ventilation, less invasive modes of respiratory support and surfactant administration have been successfully introduced in recent decades [4]. In Europe [6], surfactant is increasingly administered to neonates on noninvasive respiratory support through a feeding tube or a small catheter placed into the trachea with the aid of laryngoscopy (LISA) [7,8]. Compared to InSurE, a less invasive surfactant administration (LISA) decreases mortality, the need for mechanical ventilation, and BPD rates [9,10]. LISA techniques require laryngoscopy, a painful procedure that demands special skills [11] and is potentially associated with hemodynamic instability, hypoxia, and increased intracranial pressure [12]

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