Randomized Trial of Surfactant Therapy via Laryngeal Mask Airway vs. Brief Tracheal Intubation

Background: The Intubation-Surfactant-Extubation (INSURE) approach to treatment of respiratory distress syndrome (RDS) involves laryngoscopy and endotracheal tube (ETT) insertion, for which analgesic premedication is recommended. The laryngeal mask airway (LMA) is a potential alternative for surfactant administration while avoiding the need for sedation. A prior randomized trial compared surfactant given via LMA versus ETT using morphine premedication for INSURE, revealing a higher INSURE failure rate. We subsequently adopted remifentanil for INSURE, given its short-lasting sedative effect. Objective: …