This video demonstrates surfactant instillation via a thin catheter (the Hobart method) in a preterm infant manikin. This is the technique of minimally invasive surfactant therapy (MIST) that was used as the active therapy in the OPTIMIST-A randomized clinical trial. The study compared MIST vs sham treatment for preterm infants with respiratory distress syndrome. It found that MIST did not result in a statistically significant reduction in the composite outcome of death or bronchopulmonary dysplasia.
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The Hobart method of surfactant administration is demonstrated here in a resuscitation mannequin equivalent to a 27-week gestation, 1 kilogram, preterm infant.
A narrow-bore, semi-rigid catheter is used, which can be guided into the trachea without the need of forceps.
This catheter is inserted through the vocal cords to the desired depth via direct or video laryngoscopy.
The catheter is then pinch held at the lip and exogenous surfactant is delivered in at least 3 aliquots with a 10-second pause between each.
Surfactant dispersal from the trachea is driven by the infant's spontaneous breathing, which is promoted by tactile stimulation and supported with uninterrupted application of CPAP.
Once the entire surfactant dose is instilled, the catheter is removed and CPAP continues.
A rapid improvement in oxygen requirement and breathing mechanics would be expected after the procedure.
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