LISA Guideline

[ali]

Hi 99ers, I am currently working on a Level 3 and we are considering adopting LISA so I would be particularly interested and grateful for opinions and guideline from our European (preBrexit) colleagues who already undertake LISA. 

Many thanks in advance

Al

[Francesco Cardona]

We perform LISA routinely on all preterms < 28 wks right after birth. We do not use any premedication or analgesia. We use a gastric tube and Magill forceps for application of surfactant intratracheally. We follow a slightly modified version of the original protocol from Cologne (as published here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60986-0/fulltext).

You can find our publication on our experience with LISA here: https://www.ncbi.nlm.nih.gov/pubmed/23446061

Let me know if you need any more information.

[Schumz]

@ali We have recently started using LISA and we had a lot of disussion on what to use as premedication. ...the choices were propofol, fentanyl, morphine etc After much discussion we agreed on Fentanyl! I will have to double check if we give anything else along with it! We have developed a guideline ...which includes which baby, when and how! Only by consultants or under their supervision by senior trainees...Hope that helps. 

[Andrej Vitushka]

We use LISA for 2 years and have about 40 patients less than 1000 g of birthweight already. Data are still collecting but preliminary results are reassuring -- only 2 deaths in LISA group (including one because on NEC on third week of life), only 1 IVH III  and much less days on ventilator. Out method is close to one used by Dr. Cardona and colleagues (they were very kind and  shared the method with us). Non invasive ventilation (Pin 20-22 mbar, PEEP 5 mbar and Flow 10 l/min, about 20-30 breaths per minute) via mononasal cannula by NeoPuff-like device  is used. Frequently we do not even use Magill foceps (it is quite easy to intubate trachea by thin catheter). Caffeine Citrate as premedication. Constant suction from stomach is needed. Except episodes of apnea (usually on day 3) sometimes we meet feeding intolerance during the 1-2 day of life (maybe because of intestinal overdistend by non-invasive ventilation). Now the method looks promising.