Download PDF
Am J Perinatol 2023; 40(11): 1202-1207
DOI: 10.1055/s-0041-1733956
Original Article

Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy

Soume Bhattacharya
1   Children's Hospital, London Health Science Centre, Department of Pediatrics, Western University, London, Ontario, Canada
2   Department of Pediatrics, Western University, Children's Health Research Institute, London, Ontario, Canada
,
Brooke Read
3   Department of Respiratory Therapy, London Health Sciences Center, London, Canada
,
Michael Miller
1   Children's Hospital, London Health Science Centre, Department of Pediatrics, Western University, London, Ontario, Canada
2   Department of Pediatrics, Western University, Children's Health Research Institute, London, Ontario, Canada
,
Orlando da Silva
1   Children's Hospital, London Health Science Centre, Department of Pediatrics, Western University, London, Ontario, Canada
2   Department of Pediatrics, Western University, Children's Health Research Institute, London, Ontario, Canada
› Author Affiliations Funding O.D.S. has received professional consulting fees from BLES Biochemical Inc. in the past. BLES Biochemical Inc. did not fund the study nor had any influence in the design, data collection, and interpretation of the results. The surfactant maker did not review or revised the manuscript submitted for publication.
› Further Information
    Permissions and Reprints

Abstract

Objective Surfactant delivery via a thin endotracheal catheter during spontaneous breathing; a technique called minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant administration. Procedural details among different centers vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess suction catheters, vascular catheters, and more recently custom-built catheters for this purpose. The impact of choice of catheter on procedural success and procedural adverse effects has not been reported. Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multiaccess catheter (MAC).

Study Design This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in Southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics and data on procedural details (premedication, type of catheter, etc.) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath was compared by using Chi-square test or Fisher's test as appropriate. A p-value of less that 0.05 was considered significant.

Results A total of 139 neonates received surfactant via MIST method during the study period. Moreover, 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two group were similar. A higher proportion of neonates in Angiocath group received Atropine (100 vs. 76%, p = 0.002) and Fentanyl (98 vs. 36%, p < 0.001) than the MAC group.

The procedural success was 91% in the Angiocath group and 89% in the MAC group (p > 0.99). Multiple attempts were needed in 24% of neonates in the Angiocath group and 37% in the MAC group (p = 0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%; p = 0.012). Other rates of common adverse effects were similar between the two groups. On exploratory analysis fentanyl use held significant association with less success, more desaturation, apneic episodes, and need of positive pressure ventilation /intubation.

Conclusion The overall procedural success of MIST is similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with the Angiocath, though difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, which was related to higher use of procedural sedation in this group.

Key Points

  • MIST is emerging as a less invasive method of surfactant delivery that has proven clinical benefits.

  • Considerable, procedural variation is reported, particularly regarding choice of catheter.

  • Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart method) versus a flexible MAC.

  • High and comparable procedural success was seen in both groups.

Keywords

neonates - surfactant - minimally invasive - multiaccess catheter - angiocath


Publication History

Received: 17 March 2021

Accepted: 02 July 2021

Article published online:
24 September 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jobe AH. Lung development, surfactant and respiratory distress syndrome. Acta Paediatr Jpn 1990; 32 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 2 Lau CSM, Chamberlain RS, Sun S. Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants: A Meta-Analysis. Glob Pediatr Health. 4. Sage CA: Los Angeles, CA 2017
    PubMedGoogle Scholar
  • 3 Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017; 102 (01) F17-F23
    CrossrefPubMedGoogle Scholar
  • 4 Härtel C, Paul P, Hanke K. et al. Less invasive surfactant administration and complications of preterm birth. Sci Rep 2018; 8 (01) 8333
    CrossrefPubMedGoogle Scholar
  • 5 Klebermass-Schrehof K, Wald M, Schwindt J. et al. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology 2013; 103 (04) 252-258
    CrossrefPubMedGoogle Scholar
  • 6 Kribs A, Roll C, Göpel W. et al; NINSAPP Trial Investigators. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 2015; 169 (08) 723-730
    CrossrefPubMedGoogle Scholar
  • 7 Huo MY, Mei H, Zhang YH, Liu CZ, Hu YN, Song D. [Efficacy and safety of less invasive surfactant administration in the treatment of neonatal respiratory distress syndrome: a meta analysis]. Zhongguo Dang Dai Er Ke Za Zhi 2020; 22 (07) 721-727
    PubMedGoogle Scholar
  • 8 Kurepa D, Perveen S, Lipener Y, Kakkilaya V. The use of less invasive surfactant administration (LISA) in the United States with review of the literature. J Perinatol 2019; 39 (03) 426-432
    CrossrefPubMedGoogle Scholar
  • 9 Szczapa T, Hożejowski R, Krajewski P. Study Group. Implementation of less invasive surfactant administration in clinical practice-Experience of a mid-sized country. PLoS One 2020; 15 (07) e0235363
    CrossrefPubMedGoogle Scholar
  • 10 Rigo V, Debauche C, Maton P, Broux I, Van Laere D. Rigid catheters reduced duration of less invasive surfactant therapy procedures in manikins. Acta Paediatr 2017; 106 (07) 1091-1096
    CrossrefPubMedGoogle Scholar
  • 11 Herting E, Härtel C, Göpel W. Less invasive surfactant administration: best practices and unanswered questions. Curr Opin Pediatr 2020; 32 (02) 228-234
    CrossrefPubMedGoogle Scholar
  • 12 Jeffreys E, Hunt K, Dassios T, Greenough A. UK survey of less invasive surfactant administration. Arch Dis Child Fetal Neonatal Ed. 104. England 2019; DOI: 10.1136/archdischild-2018-316466. F567
    CrossrefPubMedGoogle Scholar
  • 13 Kribs A, Pillekamp F, Hünseler C, Vierzig A, Roth B. Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age </=27 weeks). Paediatr Anaesth 2007; 17 (04) 364-369
    CrossrefPubMedGoogle Scholar
  • 14 Kribs A, Härtel C, Kattner E. et al. Surfactant without intubation in preterm infants with respiratory distress: first multi-center data. Klin Padiatr 2010; 222 (01) 13-17
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Kanmaz HG, Erdeve O, Canpolat FE, Mutlu B, Dilmen U. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics 2013; 131 (02) e502-e509
    CrossrefPubMedGoogle Scholar
  • 16 Dargaville PA, Kamlin CO, De Paoli AG. et al. The OPTIMIST-a trial: evaluation of minimally-invasive surfactant therapy in preterm infants 25-28 weeks gestation. BMC Pediatr 2014; 14: 213
    CrossrefPubMedGoogle Scholar
  • 17 Dekker J, Lopriore E, van Zanten HA, Tan RNGB, Hooper SB, Te Pas AB. Sedation during minimal invasive surfactant therapy: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104 (04) F378-F383
    PubMedGoogle Scholar
  • 18 Göpel W, Kribs A, Ziegler A. et al; German Neonatal Network. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet 2011; 378 (9803): 1627-1634
    CrossrefPubMedGoogle Scholar
  • 19 Olivier F, Nadeau S, Bélanger S. et al. Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: a multicentre randomized control trial. Paediatr Child Health 2017; 22 (03) 120-124
    CrossrefPubMedGoogle Scholar
  • 20 Yang G, Hei M, Xue Z, Zhao Y, Zhang X, Wang C. Effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome in premature infants aged 32 to 36 weeks. Medicine (Baltimore) 2020; 99 (09) e19216
    CrossrefPubMedGoogle Scholar
  • 21 Fabbri L, Klebermass-Schrehof K, Aguar M. et al. Five-country manikin study found that neonatologists preferred using the LISAcath rather than the Angiocath for less invasive surfactant administration. Acta Paediatr 2018; 107 (05) 780-783
    CrossrefPubMedGoogle Scholar