Laryngeal mask airway used as a delivery conduit for the administration of surfactant to preterm infants with respiratory distress syndrome

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 1 800 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/APO(2)) 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/APO(2) 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. Copyright (C) 2005 S. Karger AG, Basel.