Catheter and Laryngeal Mask Endotracheal Surfactant Therapy: the CALMEST approach as a novel MIST technique

Purpose: Neonatal respiratory distress syndrome (RDS) is a major cause of mortality and morbidity among preterm infants. Although the INSURE (INtubation, SURfactant administration, Estubation) technique for surfactant replacement therapy is so far the gold standard method, over the last years new approaches have been studied, i.e. less invasive surfactant administration (LISA) or minimally invasive surfactant therapy (MIST). Here we propose an originally modified MIST, called CALMEST (Catheter And Laryngeal Mask Endotracheal Surfactant Therapy), using a particular laryngeal mask as a guide for a thin catheter to deliver surfactant directly in the trachea. Materials and methods: We performed a preliminary study on a mannequin and a subsequent in vivo pilot trial. Results and conclusions: This novel procedure is quick, effective and well tolerated and might represent an improvement in reducing neonatal stress. Ultimately, CALMEST offers an alternative approach that could be extremely useful for medical staff with low expertise in laryngoscopy and intubation.研究目的：新生儿呼吸窘迫综合征（Neonatal respiratory distress syndrome, RDS）是早产儿致死与致病的主要诱因之一。尽管用于表面活性物质替代治疗的INSURE（INtubation, SURfactant administration, Estubation）技术目前仍是金标准方案，但近年来学界已对多种新型治疗方案展开探索，即微创表面活性物质给药（less invasive surfactant administration, LISA）与微创表面活性物质治疗（minimally invasive surfactant therapy, MIST）。本研究提出一种原创改良型MIST方案，命名为CALMEST（Catheter And Laryngeal Mask Endotracheal Surfactant Therapy，即导管与喉罩气管内表面活性物质治疗），其通过特制喉罩作为引导装置，借助细导管将表面活性物质直接递送于气管内。 材料与方法：本研究先利用人体模拟模型开展预实验，随后进行体内先导临床试验。 结果与结论：该新型操作流程便捷高效、耐受性良好，或可有效减轻新生儿应激反应。最终，CALMEST为喉镜检查与气管插管操作经验不足的医护人员提供了一种极具实用价值的备选诊疗方案。