Surfactant Administration Through Laryngeal or Supraglottic Airways (SALSA): A Viable Method for Low-Income and Middle-Income Countries

Henry A. Zapata, Prem Fort, Kari D. Roberts, Dinushan C. Kaluarachchi, Scott O. Guthrie

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations


Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. A skilled health care provider is needed to perform this procedure. In lower-income and middle-income countries (LMICs), healthcare resources are often limited, leading to increased mortality of premature infants, many of whom would benefit from surfactant administration. Therefore, having a simplified procedure for delivery of surfactant without the need for advanced skills could be life-saving, potentially diminish gaps in care, and help ensure more equitable global neonatal survival rates. Modifications to the standard approach of surfactant administration have been put into practice and these include: INtubation-SURfactant-Extubation (INSURE), thin catheter surfactant administration (TCA), aerosolized surfactant, and surfactant administration through laryngeal or supraglottic airways (SALSA). Although there is a need for larger studies to evaluate the comparative effectiveness of these newer methods, these methods are being embraced by the global community and being implemented in various settings throughout the world. Because the SALSA technique does not require laryngoscopy, a provider skilled in laryngoscopy is not required for the procedure. Therefore, because of the ease of use and safety profile, the SALSA technique should be strongly considered as a viable method of delivering surfactant in LMICs.

Original languageEnglish (US)
Article number853831
JournalFrontiers in Pediatrics
StatePublished - Mar 16 2022

Bibliographical note

Publisher Copyright:
Copyright © 2022 Zapata, Fort, Roberts, Kaluarachchi and Guthrie.


  • LISA
  • LMA
  • RDS
  • aerosolized surfactant
  • global health
  • low- and middle-income countries (LMIC)
  • surfactant


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