Physiological Changes During Intubation-Surfactant-Extubation (InSurE) Procedure in Infants ≥30 Weeks' Gestation: A Retrospective Pilot Study.

Objective : To describe peri‑procedural physiological changes during the non‑premedicated Intubation–Surfactant–Extubation (InSurE) procedure in infants ≥30 weeks’ gestation with respiratory distress. Study Design : This retrospective pilot study included infants who underwent the InSurE procedure without premedication in AdventHealth Central Florida NICUs. Heart rate, respiratory rate, mean arterial pressure, oxygen saturation, and FiO₂ were recorded 3 hours before intubation, during the procedure, and 3 hours after extubation. Results : Forty‑eight infants met inclusion criteria. Physiological parameters remained stable from baseline to the intra‑procedural period with no significant changes in heart rate, respiratory rate, blood pressure, oxygen saturation, or FiO₂. By 3 hours post‑procedure, oxygen saturation improved, FiO₂ requirements decreased, respiratory rate increased, and heart rate declined slightly. Desaturation events fell from 16.2% intra‑procedure to none post‑procedure. No severe desaturation or tracheal intubation–associated events occurred. Conclusion : The non‑premedicated InSurE procedure was well‑tolerated, with stable physiology and improved oxygenation after surfactant administration.