Med J Bakirkoy. 2021; 17(1): 1-6 | DOI: 10.5222/BMJ.2021.35744

Comparison of LISA vs INSURE Technique using Nasal intermittent positive pressure ventilation (NIPPV) Support In Preterm Infants: A Randomized Controlled Trial

Nihal Akcay¹, Ayþe Sevim Gökalp², Ayla GÜNLEMEZ², Demet Oðuz², fatih kýlýçbay², Ayþe Engin Arýsoy^2
1Department of Pediatrics,Kocaeli University, Kocaeli
²Department of Neonatology, Kocaeli University, Kocaeli

Objective: Surfactant administration is usually performed by endotracheal intubation under mechanical ventilation. Less invasive surfactant administration (LISA) technique has became widespread in recent years, in order to prevent the risk of barotrauma and volutrauma caused by mechanical ventilation and intubation. The aim of this prospective study is to evaluate the effectiveness of surfactant administration via a thin catheter during spontaneous breathing on NIPPV and to compare with INSURE method.
Method: Seventy-eight preterm infants who were born at university hospital with less than 34 weeks of gestational age and who received surfactant therapy were enrolled. The intratracheal administration of poractant alfa (CUROSURF®) was performed using umbilical catheters in LISA group (n= 42). INSURE group had 36 infants who were intubated, received surfactant then extubated and placed on NIPPV.
Results: There were no statistically significant differences between two groups in terms of intubation in the first 72 hours and re-administration of surfactant, the duration of NIPPV and the occurence of pneumothorax, pulmonary hemorrhage, patent ductus arteriosus, intraventricular hemorrhage, early onset neonatal sepsis, necrotising enterocolitis, bronchopulmonary dsyplasia and mortality (p>0.05). The pCO2 values decreased faster in LISA group when compared to INSURE group and this difference was statistically significant (p<0.05).
Conclusions: LISA procedure under NIPPV seems to provide better pCO2 levels and does not increased the mortality and morbidity due to technique. Although the results seem to be promising, we need further investigations and larger series.

Keywords: INSURE, LISA, Preterm, Surfactant

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Preterm Bebeklerde Nazal Aralýklý Pozitif Basýnçlý Ventilasyon (NIPPV) Desteði kullanýlarak LISA ile INSURE Tekniðinin Karþýlaþtýrýlmasý: Randomize Kontrollü Bir Çalýþma

Nihal Akcay¹, Ayþe Sevim Gökalp², Ayla GÜNLEMEZ², Demet Oðuz², fatih kýlýçbay², Ayþe Engin Arýsoy^2
1Kocaeli Üniversitesi Týp Fakültesi, Çocuk Saðlýðý ve hastalýklarý Ana Bilim Dalý, Kocaeli
²Kocaeli Üniversitesi Týp Fakültesi, Neonatoloji Bilim Dalý, Kocaeli

Amaç: Sürfaktan uygulamasý genellikle mekanik ventilasyon altýnda endotrakeal entübasyon ile yapýlýr. Mekanik ventilasyon ve entübasyonun neden olduðu barotravma ve volutravma riskini önlemek için son yýllarda daha az invaziv sürfaktan uygulama teknikleri yaygýnlaþmýþtýr. Bu prospektif çalýþmanýn amacý, NIPPV'de spontan solunum sýrasýnda ince bir kateter yoluyla sürfaktan uygulamasýnýn etkinliðini deðerlendirmek ve INSURE yöntemiyle karþýlaþtýrmaktýr.
Yöntem: Kocaeli Üniversitesi Hastanesi'nde 34 haftadan küçük doðan ve sürfaktan tedavisine ihtiyaç duyan yetmiþ sekiz preterm bebek çalýþmaya dahil edildi. LISA grubunda spontan solunum sýrasýnda laringoskopi altýnda göbek kateterleri kullanýlarak sürfaktanýn trakeal uygulamasý (n = 42) yapýldý. INSURE grubundaki bebekler entübe edildi, 200 mg / kg sürfaktan uygulamasýndýktan sonra 30
saniye boyunca pozitif basýnçlý ventilasyon(n=36) uygulandý. Daha sonra ekstübe edildi ve hemen NIPPV'ye alýndý.
Bulgular: Ýki grup arasýnda ilk 72 saatte entübasyon ihtiyacý ve sürfaktanýn tekrar uygulanmasý, NIPPV süresi, pnömotoraks, pulmoner kanama, patent duktus arteriozus insidansý, intraventriküler kanama, erken sepsis, nekrotizan enterokolit, bronkopulmoner displazi ve mortalite oranlarý arasýnda fark yoktu. Parsiyel karbondioksit deðerleri LISA grubunda InSurE grubuna göre daha hýzlý düþtü ve bu istatistiksel olarak anlamlýydý.
Sonuçlar: LISA entübasyon gerektirmez, ayrýca uygulanmasý basit ve kolaydýr. Sonuçlar umut verici gibi görünse de, daha fazla araþtýrmaya ve daha geniþ serilere ihtiyacýmýz var.

Anahtar Kelimeler: ÝNSURE, LÝSA, Pretem, Sürfaktan,

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