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LISA/MIST: Complex clinical problems almost never have easy solutions
Daniele De Luca1, Shivani Shankar-Aguilera2, Eduardo Bancalari3
1Division of Paediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
Seminars in Fetal & Neonatal Medicine
|March 24, 2021
Summary
Less invasive surfactant administration (LISA) techniques may be overestimated. Current evidence suggests LISA is better than poor invasive ventilation, but high-quality studies are needed to optimize its use in preterm infants.
Area of Science:
- Neonatal respiratory support
- Pulmonology
- Pediatric critical care
Background:
- Newer surfactant administration methods, termed less invasive surfactant administration (LISA), are promoted for reduced invasiveness.
- The clinical benefits of LISA are potentially overestimated due to limited biological and pathophysiological rationale.
- Existing clinical trials investigating LISA often lack robust translational data and exhibit significant methodological flaws.
Purpose of the Study:
- To critically review the available clinical data on LISA techniques in preterm neonates.
- To evaluate the biases and limitations within current LISA research.
- To highlight the insufficient pathophysiological background supporting LISA's purported benefits.
Main Methods:
- Comprehensive evidence-based review of published clinical trials and literature on LISA.
- Analysis of study designs, parameters, and outcomes in LISA investigations.
- Assessment of the biological and pathophysiological basis for LISA.
Main Results:
- Current data indicate LISA is superior to prolonged, unrestricted invasive ventilation with poorly defined parameters.
- The comparison group (invasive ventilation) represents a suboptimal standard of care, potentially inflating LISA's perceived efficacy.
- Significant gaps exist in understanding optimal analgesia/sedation and surfactant titration for LISA.
Conclusions:
- The clinical potential of LISA is likely overestimated based on current flawed evidence.
- High-quality, well-designed studies are essential to determine the true efficacy and optimal application of LISA.
- Further research should focus on refining LISA protocols, including sedation and surfactant dosing, for preterm neonates.
