140 - Implementation of Surfactant Administration through Laryngeal Mask or Supraglottic Airway (SALSA) as part of a Gentle Ventilation approach

Publication Number: 3134.140

Arleena Rupnaraine, University of Florida, Gainesville, FL, United States; Keren Fishman, University of Florida College of Medicine, Gainesville, FL, United States; Kaitlyn Lagnese, University of Florida College of Medicine, Gainesville, FL, United States; Daniel Ralph. Gipson, Norton Children’s Hospital / University of Louisville School of Medicine, Louisville, KY, United States; Helen Hu, University of Florida College of Medicine, GAINESVILLE, FL, United States

Background: Surfactant Administration through Laryngeal or Supraglottic Airway (SALSA) is a minimally invasive technique that delivers surfactant while maintaining spontaneous breathing and avoiding endotracheal intubation in infants with respiratory distress syndrome (RDS). Evidence suggests SALSA may decrease exposure to mechanical ventilation and associated complications compared with traditional methods. A quality improvement initiative was implemented in our level IV NICU to introduce and standardize SALSA as part of a gentle ventilation bundle.

Objective: The primary aim was to increase the proportion of eligible infants receiving SALSA from 0% to ≥50% over a 6-month implementation period (04/2024-09/2024) and sustain compliance over the subsequent period (10/2024-09/2025).

Design/Methods: Eligibility criteria for SALSA included premature infants with RDS < 72 hours old, birthweight ≥ 2kg, and stabilized on maximum non-invasive support ( < 28 weeks’ gestation: FiO₂>30%, PEEP≥6 cmH₂O, ≥28 weeks’ gestation: FiO₂>40%, PEEP≥7 cmH₂O). All infants receiving surfactant for RDS were reviewed for eligibility. Interventions included multidisciplinary staff education, bedside simulation training, clinical practice guideline revisions, and procedural checklists. Process measures were SALSA compliance and balancing measures included rate of adverse events associated with SALSA administration. Clinical outcome measures included CPAP failure (need for mechanical ventilation within 72 hours of surfactant) and duration of positive pressure ventilation compared between baseline and post-implementation periods.

Results: Surfactant delivery from 04/2021- 04/2024 was exclusively via traditional intubation methods. SALSA eligibility tracking started in 02/2024. During the study period (04/2024-10/2025), a total of 22 infants were eligible for minimally invasive surfactant administration. SALSA compliance increased from 0% to 100% during the implementation phase (04/2024-09/2024) and was sustained at 72% during the sustainment phase, with an overall compliance rate of 78% over the project period. A total of 3 infants received SALSA despite not meeting criteria. CPAP failure rates were unchanged between baseline and implementation. The median duration of positive pressure ventilation decreased from 32.5 days (IQR 6.3-115.8) to 22.7 days (6.0-106.6).

Conclusion(s): Targeted QI efforts increased minimally invasive surfactant administration use without worsening CPAP failure rate or duration of positive pressure ventilation. Sustained education and protocol adherence are key to maintaining these improvements.