2011 OPEN FORUM Abstracts
LARYNGEAL MASK AIRWAY FOR SURFACTANT ADMINISTRATION IN AN ANIMAL MODEL.
Brenda J. Plumm1, Patricia Meyers1, Cathy Worwa1, Andrea Lampland1,2, Mark Mammel1,2, Kari Roberts2; 1Infant Diagnostic and Research Center, Children's Hospitals and Clinic of Minnesota, St. Paul, MN; 2Department of Pediatrics, University of Minnesota, Minneapolis, MN
Background: Surfactant therapy has dramatically improved outcomes of infants with RDS. Currently, intubation with an endotracheal tube (ETT) is required to deliver surfactant. Intubation, however, is an invasive procedure associated with adverse physiologic effects. If proven effective, the laryngeal mask airway (LMA) would provide a means of delivering surfactant while avoiding the need for intubation. We hypothesized that administration of surfactant through an LMA is as effective as administration through an ETT and that time and physiologic changes during instrumentation will be less in the LMA group. Methods: This study is a randomized, controlled trial using newborn piglets. Lung injury was induced via surfactant washout using normal saline. Animals were randomized into 3 groups: 1) LMA placed, no surfactant administered (control; n= 8); 2) surfactant (lucinactant, Discovery Laboratories, Warrington, PA) via an LMA (LMA group; n = 8); and 3) surfactant via an ETT (ETT group; n = 8). Physiologic data were recorded throughout the 3.5 hour study and analyzed using ANOVA. Results: We demonstrated that partial pressure of oxygen in arterial blood (PaO2) levels of the LMA and ETT groups were significantly increased compared to controls (p< 0.05). LMA and ETT groups were not statistically different. Heart rate, blood pressure and pH did not differ between groups. Time for successful placement of LMA was 19 1.9 +/- 6 seconds vs ETT 98 1.9 +/- 108 seconds (p= 0.0015); number of attempts required for successful LMA placement was 1.1 1.9 +/- 0.34 vs ETT 1.9 +/- 1.7 (p=0.0294). Conclusion: Administration of surfactant via an LMA compared with an ETT resulted in similar improvements in oxygenation. Placement of the device required less time and fewer attempts. Data suggest that further study in human neonates is justified. If proven effective, some infants with respiratory distress may be able to receive surfactant while avoiding intubation.
Sponsored Research - Neonatal Resuscitation Program, American Academy of Pediatrics
Childrens Hospitals and Clinics of Minnesota
Surfactant donated by Discovery Laboratories, Inc