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Abstract：
Minimally invasive surfactant therapy (MIST) has emerged as a preferred method of surfactant delivery. Pioneers of this technique have described the use of direct laryngoscopy (DL) for MIST. With the increasing application of video laryngoscopy (VL) for neonatal airway management, it is speculated that MIST techniques can be adapted for use with VL.
OBJECTIVE: To compare procedural success, operator ease of use, and complication of MIST using VL vs. MIST using DL.
METHODS: This was a retrospective, observational cohort study conducted at a tertiary-level neonatal intensive care unit after obtaining ethical approval. We included neonates who received MIST between 1 October 2020 and 31 October 2022. Baseline demographic characteristics, along with procedural data, were collected. Primary outcome measures included the overall procedural success rate, the need for multiple attempts, and the total number of attempts. Secondary outcome measures included the occurrence of adverse events, the need for a second dose of surfactant, and the need for intubation within 7 days of the procedure. Means and SDs, independent t-tests, frequencies, and chi-square were used as appropriate. p-values < 0.05 were considered statistically significant.
RESULTS: Of the 79 neonates included, 37 neonates received MIST via VL, while 42 received MIST via DL. The median gestational age was lower in the VL group at 29.0 weeks vs. 30.5 weeks (p = 0.011) in the DL group. The median birthweight in the VL group was 1260 g, IQR (1080, 1690), which was significantly lower than the DL group, which was 1575 g, IQR (1220, 2251), p = 0.028. Purpose-built catheter use was higher in the DL group. The overall procedural success was similar between groups. The need for multiple attempts was lower with VL in comparison to DL [4 (11%) vs. 13 (31%); p = 0.034)] at the univariate level but not significant at multivariate analysis (p = 0.131). Procedural complications, the need for a second dose of surfactant, the need for mechanical ventilation post-MIST, and operator ease of use were similar. User comments emphasized the value of VL in providing real-time visual information to confirm catheter placement and guide operators/trainees.
CONCLUSIONS: Overall, in our cohort, despite VL being a more recently adapted technology used more in smaller, sicker, and more premature neonates, procedural success, complications, and operator ease of use for MIST using VL and DL were comparable. Our findings show the successful application of VL for MIST and suggest procedural advantages that might facilitate universal adoption.
OBJECTIVE: To compare procedural success, operator ease of use, and complication of MIST using VL vs. MIST using DL.
METHODS: This was a retrospective, observational cohort study conducted at a tertiary-level neonatal intensive care unit after obtaining ethical approval. We included neonates who received MIST between 1 October 2020 and 31 October 2022. Baseline demographic characteristics, along with procedural data, were collected. Primary outcome measures included the overall procedural success rate, the need for multiple attempts, and the total number of attempts. Secondary outcome measures included the occurrence of adverse events, the need for a second dose of surfactant, and the need for intubation within 7 days of the procedure. Means and SDs, independent t-tests, frequencies, and chi-square were used as appropriate. p-values < 0.05 were considered statistically significant.
RESULTS: Of the 79 neonates included, 37 neonates received MIST via VL, while 42 received MIST via DL. The median gestational age was lower in the VL group at 29.0 weeks vs. 30.5 weeks (p = 0.011) in the DL group. The median birthweight in the VL group was 1260 g, IQR (1080, 1690), which was significantly lower than the DL group, which was 1575 g, IQR (1220, 2251), p = 0.028. Purpose-built catheter use was higher in the DL group. The overall procedural success was similar between groups. The need for multiple attempts was lower with VL in comparison to DL [4 (11%) vs. 13 (31%); p = 0.034)] at the univariate level but not significant at multivariate analysis (p = 0.131). Procedural complications, the need for a second dose of surfactant, the need for mechanical ventilation post-MIST, and operator ease of use were similar. User comments emphasized the value of VL in providing real-time visual information to confirm catheter placement and guide operators/trainees.
CONCLUSIONS: Overall, in our cohort, despite VL being a more recently adapted technology used more in smaller, sicker, and more premature neonates, procedural success, complications, and operator ease of use for MIST using VL and DL were comparable. Our findings show the successful application of VL for MIST and suggest procedural advantages that might facilitate universal adoption.
摘要：
微创表面活性剂治疗(MIST)已成为表面活性剂递送的优选方法。该技术的先驱已经描述了将直接喉镜（DL）用于MIST。随着视频喉镜(VL)在新生儿气道管理中的应用越来越多,据推测，MIST技术可以适用于VL。
目的：为了比较手术成功，操作员易于使用，使用VL与MIST的并发症MIST使用DL。
方法：这是一个回顾性研究，在获得伦理批准后在三级新生儿重症监护病房进行的观察性队列研究.我们包括在2020年10月1日至2022年10月31日期间接受MIST的新生儿。基线人口统计特征，连同程序数据，被收集。主要结果指标包括总体程序成功率，需要多次尝试，以及尝试的总数。次要结局指标包括不良事件的发生，需要第二剂表面活性剂，以及手术后7天内需要插管。手段和SDs，独立t检验，频率,适当使用卡方。P值<0.05被认为是统计学上显著的。
结果：在79例新生儿中，37名新生儿通过VL接受了MIST，而42则通过DL接收了MIST。VL组的中位胎龄在29.0周较低。DL组30.5周(p=0.011)。VL组的中位出生体重为1260g，IQR(1080,1690),显著低于DL组，1575克，IQR（1220，2251），p=0.028。DL组的专用导管使用率更高。两组之间的总体程序成功相似。与DL[4（11％）相比，VL对多次尝试的需求较低。13（31％）；p=0.034）]在单变量水平上，但在多变量分析中不显著（p=0.131）。手术并发症,需要第二剂表面活性剂，MIST后机械通气的需要，和操作员的易用性相似。用户评论强调了VL在提供实时视觉信息以确认导管放置和指导操作员/受训者方面的价值。
结论：总体而言，在我们的队列中，尽管VL是一种较新的适应技术，病情加重,更多的早产儿，程序上的成功,并发症,使用VL和DL的MIST的操作员易用性具有可比性。我们的发现表明VL在MIST中的成功应用，并提出了可能促进普遍采用的程序优势。
目的：为了比较手术成功，操作员易于使用，使用VL与MIST的并发症MIST使用DL。
方法：这是一个回顾性研究，在获得伦理批准后在三级新生儿重症监护病房进行的观察性队列研究.我们包括在2020年10月1日至2022年10月31日期间接受MIST的新生儿。基线人口统计特征，连同程序数据，被收集。主要结果指标包括总体程序成功率，需要多次尝试，以及尝试的总数。次要结局指标包括不良事件的发生，需要第二剂表面活性剂，以及手术后7天内需要插管。手段和SDs，独立t检验，频率,适当使用卡方。P值<0.05被认为是统计学上显著的。
结果：在79例新生儿中，37名新生儿通过VL接受了MIST，而42则通过DL接收了MIST。VL组的中位胎龄在29.0周较低。DL组30.5周(p=0.011)。VL组的中位出生体重为1260g，IQR(1080,1690),显著低于DL组，1575克，IQR（1220，2251），p=0.028。DL组的专用导管使用率更高。两组之间的总体程序成功相似。与DL[4（11％）相比，VL对多次尝试的需求较低。13（31％）；p=0.034）]在单变量水平上，但在多变量分析中不显著（p=0.131）。手术并发症,需要第二剂表面活性剂，MIST后机械通气的需要，和操作员的易用性相似。用户评论强调了VL在提供实时视觉信息以确认导管放置和指导操作员/受训者方面的价值。
结论：总体而言，在我们的队列中，尽管VL是一种较新的适应技术，病情加重,更多的早产儿，程序上的成功,并发症,使用VL和DL的MIST的操作员易用性具有可比性。我们的发现表明VL在MIST中的成功应用，并提出了可能促进普遍采用的程序优势。
