2. General Background
What is Surfactant ?
Classifications of Surfactant.
Surfactant Deficiency
Without surfactant
The Golden Rule
3. Strategies in administering of
surfactant
Prophylactic Surfactant administration
Rescue or Therapeutic Surfactant administration
4. Prophylactic administration may be
indicated in :
infants at high risk of developing RDS because
of short gestation (< 32 weeks)or low birth
weight
(< 1,300 g) which strongly suggest lung
immaturity.
infants with laboratory evidence of surfactant
deficiency such as lecithin/sphingomyelin ratio
less than 2:1
5. Rescue or therapeutic
administration is indicated in
who require endotracheal intubation and mechanical
ventilation because :
increased work of breathing as indicated by Experiencing
signs of respiratory distress
increasing oxygen requirements as indicated by pale or
cyanotic skin color, agitation, and decreases in PaO2, SaO2, or
SpO2 mandating an increase in FIO2.
Clinical and radiographic evidence of neonatal RDS or MAS
8. Administration equipments
A warmed vial of Survanta ( 2 may be needed)
10 cc syringe with needle
NG tube
Sterile gloves with sterile field
Sterile scissor
9. Timing of Surfactant Administration
early rescue treatment (within a few hours after
delivery) of RDS
prophylactic use (within minutes)
Both have been shown to decrease mortality, air-leaks
and possibly even the incidence of
bronchopulmonary dysplasia in preterm infants
requiring mechanical ventilation.
10. Administering of Surfactant
Surfactant should be administered rapidly, using
the recommended dose with the infant in the
supine position
Or
in equal aliquots in the right and left lateral
position ( 2 persons are needed *)
11. One approach of practice
Surfactant is warmed to room temperature by leaving the
vial at room temperature for 20 minutes or hold it for 8
minutes and never shake it .
Ensure correct endotracheal tube (ETT) position.
Check ETT length at lips.
listen for bilateral air entry and look for chest movement
chest X-ray not necessary before first dose
12. The ventilator settings are to be adjusted by the
respiratory therapist prior to dosing of surfactant to
maximize dispersion.
The ventilator should be in the time cycled pressure
limited mode .
The rate is set 40 breaths/min unless requiring a rate >40
breaths/min prior to dosing of surfactant.
The FiO2 is set to maintain oxygen saturations ≥ 92%.
13. The PIP and itime to remain the same.
Determine target tidal volume based on weight Remove flow
sensor prior to dosing.
The infant is placed on a flat bed surface, positioned on the
right side to receive one aliquot during a 2-3 second time
period.
The infant remains on his right side for 30 seconds.
The infant is turned to his left side and the second aliquot is
administered during a 2-3 second time period.
14. Attention pls
If during or immediately after Surfactant
administration oxygen saturation falls associated
with lack of chest movement, increase the PIP
until good chest movement is observed, then
once condition improves try to reduce PIP to
original levels.
15. POST DOSING
document oxygen saturation, pO2, pCO2,
ventilator settings, FiO2, and notable events
every 10 minutes for 30 minutes. Then revert to
normal frequency of observations
avoid suctioning the endotracheal tube for 2
hours post-administration unless clear-cut signs
of airway obstruction are present.
16. ASSESSMENT OF OUTCOME:
Administration of surfactant leads to rapid
improvement of oxygenation accompanied by
an increase of functional residual capacity and
lung compliance and decreased work of
breathing …..
17. Whose in charge :
proper use, understanding, and mastery of the equipment
and technical aspects of surfactant replacement therapy.
comprehensive knowledge and understanding of neonatal
ventilator management and pulmonary anatomy and
pathophysiology
neonatal patient assessment skills, including the ability to
recognize and respond to adverse reactions and/or
complications of the procedure……….
18. FREQUENCY :
Repeat doses of surfactant are depends on the
continued diagnosis of RDS.
Additional doses of surfactant, given at 6- to 24-
hour intervals
may be indicated in infants who experience
increasing ventilator requirements or whose
conditions fail to improve after the initial dose
19. CONTRAINDICATIONS
the presence of congenital anomalies
incompatible with life beyond the neonatal
period.
respiratory distress in infants with laboratory
evidence of lung maturity…………
20. HAZARDS
Procedural complications include:
plugging of endotracheal tube (ETT) by surfactant
hemoglobin desaturation and increased need for
supplemental O2.
bradycardia due to hypoxia
tachycardia due to agitation, with reflux of surfactant into
the ETT………
21. Physiologic complications :
Apnea
pulmonary hemorrhage
marginal increase in retinopathy of prematurity
barotrauma resulting from increase in lung
compliance following surfactant replacement and
failure to change ventilator settings accordingly
22. LIMITATIONS
Surfactant administered prophylactically may be given to
some infants in whom RDS would not have developed.
When surfactant is administered prophylactically in the
delivery room, ETT placement may not have been verified
by chest radiograph resulting in the inadvertent
administration to only one lung or to the stomach.
Tracheal suctioning should be avoided following
surfactant administration………..
