title: A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates.
abstract: OBJECTIVE
  To compare the short-term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube.
  
  
  METHODS
  Preterm infants (28-35 weeks of gestational age), weighing 1kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2)≥0.40 to maintain oxygen saturation 91-95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2≤0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24h, MV requirement, and presence of surfactant in gastric content.
  
  
  RESULTS
  Forty-eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p=0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups.
  
  
  CONCLUSIONS
  Surfactant administration by LMA showed short-term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results.
authors.affiliation: Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil; Maternidade UNIMED-BH, Unidade de Terapia Intensiva Neonatal, Belo Horizonte, MG, Brazil. Electronic address: rosilu@gmail.com.
authors.forename: Rosilu F
authors.initials: RF
authors.lastname: Barbosa
authors.affiliation: Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Simões E Silva
authors.affiliation: Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil; Hospital Lifecenter, Departamento de Anestesia, Belo Horizonte, MG, Brazil.
authors.forename: Yerkes P
authors.initials: YP
authors.lastname: Silva
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D008297:Male; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants
keywords: Laryngeal mask airway; Máscara laríngea; Neonato prematuro; Preterm infant; Pulmonary surfactant; Surfactante pulmonar