INSURE Strategies

Conventional RDS Treatment Strategies (Respiratory Distress Syndrome)
Conventional Treatment Strategies
Pharmacy Considerations
Pharmacy Considerations
Leading the way to fast RDS (Respiratory Distress Syndrome) success
Leading the Way

Improving the picture in RDS treatment

Today’s treatment protocols for RDS have shifted away from routine conventional intubation and subsequent mechanical ventilation (MV).1 While initial stabilization on nCPAP has proven to be a viable option for spontaneously breathing infants at risk for RDS,2-6 studies suggest approximately 50% of infants may require subsequent intubation and selective surfactant administration.4-7

It is important to note that the INSURE strategy may not be appropriate for all infants. Infants with RDS may vary markedly in the severity of respiratory disease, maturity, and presence of other complications, and thus it is necessary to individualize patient care.

The INSURE strategy: established benefits of surfactant, while avoiding prolonged MV8

INSURE Strategy for the treatment of RDS in infants: Intubation Surfactant Rapid Extubation
  • In some clinical studies, infants treated with CUROSURF using the INSURE strategy were generally extubated within approximately 5 to 10 minutes following surfactant administration9-12
  • Extubation should be performed when the infant is stable at the discretion of the clinician
  • Early rescue INSURE strategy following nCPAP failure may help avoid potential for respiratory insufficiency and the need for subsequent MV8
  • In studies, early rescue INSURE strategy (FiO2<0.45) was associated with improved outcomes vs late selective therapy (FiO2>0.45)8
  • Rapid extubation after surfactant administration may not be achievable or desirable in the most immature infants, and decisions to extubate should be individualized

New recommendations for initial respiratory support3

2014 American Academy of Pediatrics Recommendations3

American Academy of Pediatrics (2014) gives a strong recommendation of CPAP immediately after birth with subsequent selective surfactant administration considered as an alternative to routine intubation and if respiratory support with a ventilator is likely needed, early administration of surfactant followed by rapid extubation is preferable to prolonged ventilation.

Adapted from Committee on Fetus and Newborn. Respiratory Support in Preterm Infants at Birth. Pediatrics. 2014

Surfactant choice may facilitate early rescue INSURE

It is important to consider composition, volume, effect on respiratory parameters, redosing requirements, and clinical evidence when evaluating a surfactant for use with INSURE.13-15

Consider the fit of your surfactant

Consider volume & viscosity for efficient administration, effect on respiratory paraments, redosing, & clinical evidence when evaluating a surfactant for use with INSURE.

It is important to note that the INSURE strategy may not be appropriate for all infants. Infants with RDS may vary markedly in the severity of respiratory disease, maturity, and presence of other complications, and thus it is necessary to individualize patient care.