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Review
. 2022 Mar 16:10:853831.
doi: 10.3389/fped.2022.853831. eCollection 2022.

Surfactant Administration Through Laryngeal or Supraglottic Airways (SALSA): A Viable Method for Low-Income and Middle-Income Countries

Henry A Zapata  1 , Prem Fort  2   3 , Kari D Roberts  4 , Dinushan C Kaluarachchi  1 , Scott O Guthrie  5
Affiliations
Review

Surfactant Administration Through Laryngeal or Supraglottic Airways (SALSA): A Viable Method for Low-Income and Middle-Income Countries

Henry A Zapata et al. Front Pediatr. .

Abstract

Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. A skilled health care provider is needed to perform this procedure. In lower-income and middle-income countries (LMICs), healthcare resources are often limited, leading to increased mortality of premature infants, many of whom would benefit from surfactant administration. Therefore, having a simplified procedure for delivery of surfactant without the need for advanced skills could be life-saving, potentially diminish gaps in care, and help ensure more equitable global neonatal survival rates. Modifications to the standard approach of surfactant administration have been put into practice and these include: INtubation-SURfactant-Extubation (INSURE), thin catheter surfactant administration (TCA), aerosolized surfactant, and surfactant administration through laryngeal or supraglottic airways (SALSA). Although there is a need for larger studies to evaluate the comparative effectiveness of these newer methods, these methods are being embraced by the global community and being implemented in various settings throughout the world. Because the SALSA technique does not require laryngoscopy, a provider skilled in laryngoscopy is not required for the procedure. Therefore, because of the ease of use and safety profile, the SALSA technique should be strongly considered as a viable method of delivering surfactant in LMICs.

Keywords: LISA; LMA; RDS; SALSA; aerosolized surfactant; global health; low- and middle-income countries (LMIC); surfactant.

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Conflict of interest statement

PF, KR, and SG have worked for and received payments from ONY Biotech in the past. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer AP declared past co-authorships with one of the authors KR and the absence of any ongoing collaboration with any of the authors to the handling editor.

Figures

Figure 1
Figure 1
SALSA: Step-by-step guidelines.
Figure 2
Figure 2
Instructional video 1 provides an overview and step-by-step instructions on how to administer surfactant via SALSA technique. All patient consents were obtained in accordance with policies at University of Minnesota (Courtesy of Dr. Kari Roberts). (A) Demonstrates insertion of LMA, (B) Illustrates final position of LMA, (C) A piece of tubing connected to the surfactant syringe is placed into the lumen of the device to deliver surfactant, (D) LMA removal.
Figure 3
Figure 3
Access videos using the following QR codes. (A) access video 1, (B) access video 2.
See this image and copyright information in PMC

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