Related Experiment Video
Updated: Aug 3, 2025

Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
Published on: July 14, 2023
Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative
Dalibor Kurepa1, Vitaliya Boyar2, Olena Predtechenska3
1Division of Neonatology, Cohen Children's Medical Center, New Hyde Park, New York, USA dkurepa@northwell.edu.
Objective:
To describe the use of quality improvement methodology in transitioning from delivery of surfactant by INSURE (INtubation-SURfactant administration-Extubation) to video laryngoscope-assisted LISA (less-invasive surfactant administration) for infants with respiratory distress syndrome (RDS) receiving non-invasive ventilatory support.
Setting:
Two large neonatal intensive care units (NICUs) at Northwell Health (New Hyde Park, New York, USA).
Study Population:
Infants with RDS receiving continuous positive airway pressure in the NICU and eligible for surfactant administration.
Results:
LISA was initiated in our NICUs in January 2021, after extensive guideline development, education programmes, hands-on training and provider credentialing. Our Specific, Measurable, Achievable, Relevant and Timely aim was to deliver surfactant by LISA for 65% of total doses by 31 December 2021. This goal was achieved within 1 month of go-live. In total, 115 infants received at least one dose of surfactant during the year. Of those, 79 (69%) received it via LISA and 36 (31%) via INSURE. Two Plan-Do-Study-Act cycles contributed to improved adherence to guidelines on timely surfactant administration and both written and video documentation.
Conclusions:
Safe and effective introduction of LISA with the use of video laryngoscopy is achievable with careful planning, clear clinical guidelines, adequate hands-on training and comprehensive safety and quality control.
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