Outcomes, safety and health economics of introduction of video laryngoscopy-assisted less invasive surfactant administration

Abstract

Background: Less invasive surfactant administration (LISA) is associated with better outcomes than InSurE (Intubation-Surfactant administration-Extubation). Video-laryngoscopy (VL) facilitates intubation in neonates, however safety and cost-effectiveness of VL-assisted LISA have not been evaluated.

Methods: We compared the outcomes of infants receiving VL-assisted LISA (n = 67) with a historical cohort of infants who received InSurE (n = 52). Secondary aims were to evaluate safety and cost-effectiveness.

Results: VL-assisted LISA was associated with reduced duration of non-invasive ventilation (NIV), reduced duration of oxygen therapy, reduced composite days on NIV and mechanical ventilation (MV), and shorter NICU stay with lower hospital costs for infants ≥29 weeks GA, compared to InSurE. In the VL-assisted LISA group, 66% of the tracheal catheters were placed on the first attempt and 16% of infants displayed desaturation during placement.

Conclusion: In infants ≥29 weeks GA, VL-assisted LISA reduced exposure to NIV, oxygen, NIV and MV combined, length of stay, and cost of care compared to InSurE.

Fig. 1

Patient inclusion flow chart.

Fig. 2. Average cost of care.

Graph shows the average total cost of care (US Dollars) for both the entire InSurE and LISA cohorts and stratified by gestational ages. The average total cost of care was calculated by the sum of the evaluated average cost per day with mechanical ventilation (darker gray bars) and the average cost per day without mechanical ventilation (lighter gray bars). ***p < 0.001. (Overall) InSurE (n = 52) $191,455.27 ± $114,923.42; LISA (n = 67) $158,434.13 ± $92,208.71. (23-25 6/7) InSurE (n = 9) $249,195.89 ± $102,748.89; LISA (n = 13) $185,798.92 ± $133,091.50. (26-28 6/7) InSurE (n = 24) $191,779.17 ± $108,031.78; LISA (n = 33) $193,368.85 ± $73,309.45. (29-31 6/7) InSurE (n = 19) $163,695.32 ± $123,836.44; LISA (n = 21) $86,596.62 ± $30,201.09. InSurE intubation–surfactant administration–extubation, LISA less-invasive surfactant administration, MV mechanical ventilation.