275 - Technical aspects of device positioning with LISA vs. INSURE: a crossover randomized controlled manikin trial.

Poster Number: 275
Publication Number: 275.331

nicoletta doglioni, NEONATAL INTENSIVE CARE UNIT, Azienda Ospedale-Università di Padova, padova, Veneto, Italy; FRANCESCO CAVALLIN, Independent statistician, Solagna, Italy, Solagna, Veneto, Italy; BENEDETTA BUA, Department of Women's and Children's Health, University of Padova, Padova, Italy, Padova, Veneto, Italy; ELISA PASTA, Fondazione Poliambulanza Brescia, Bergamo, Lombardia, Italy; Federica Savio, Università degli studi di Padova, Padova, Veneto, Italy; PAOLO ERNESTO P. VILLANI, Poliambulanza Foundation Hospital Brescia, Brescia Italy, Lombardia, Italy; DANIELE TREVISANUTO, University of Padova: Department of Women' and Children Health, PADOVA, Veneto, Italy

Background: Respiratory distress syndrome (RDS) is a major issue in preterm infants, accounting for about 80% of babies born at 28 weeks' gestation and 90% of those born at 24 weeks' gestation. Surfactant replacement plays a crucial role in the management of RDS. Intubation-Surfactant-Extubation (INSURE) technique has been endorsed as it provides surfactant administration without mechanical ventilation and may reduce bronchopulmonary dysplasia (BPD). During the last decade, further less invasive approaches for surfactant administration have been promoted, including LISA (less invasive surfactant administration).Recent literature suggests that LISA is superior in reducing need for mechanical ventilation and risk of death or BPD. Although LISA offers some clinical advantages over INSURE in surfactant administration, open issues remain on technical aspects.

Objective: The present study aimed to compare the time of device positioning with LISA vs. INSURE in a manikin simulating an extremely low birth weight infant. Further, the success of device positioning and operator’s opinion were evaluated.

Design/Methods: A randomized controlled crossover (AB/BA) trial of surfactant administration with LISA vs. INSURE in a manikin simulating an extremely low birth weight infant. Forty-two tertiary hospital consultants and pediatric residents with previous experience with LISA and INSURE participated.The primary outcome measure was the time of device positioning. The secondary outcome measures were: success of the first attempt, number of attempts, correct depth, and participant’s opinion on difficulty in using the device.

Results: Median time of device positioning was shorter with LISA vs. INSURE (median difference -8 seconds, 95% confidence interval -16 to -1 seconds; p=0.04). Success at first attempt was 35/40 with LISA (83%) and 31/40 with INSURE (74%) (p=0.42). Median number of attempts was 1 (IQR 1-1) with LISA and 1 (IQR 1-2) with INSURE (p=0.08). Correct depth was achieved in 30/40 with LISA (71%) and 37/40 with INSURE (88%) (p=0.12). Participants found LISA easier to insert in the trachea (p=0.002) but INSURE easier to place at the correct depth (p=0.008). Handling the device (p=0.43), visualizing the glottis (p=0.17) and overall difficulty in using the device (p=0.13) were not statistically different.Conclusion(s): In a preterm manikin model, positioning a thin catheter (LISA) was quicker and easier than a tracheal tube (INSURE), but the magnitude of the difference was unlikely to be clinically relevant and the tracheal tube was easier to place at the correct depth.
Participants’ opinions about difficulty in using the device (evaluated using a Likert scale).