SRT

Mohammed Al Nadhri

RT Intern

N3510675

General Background

What is Surfactant ?

Classifications of Surfactant.

Surfactant Deficiency

Without surfactant

The Golden Rule

Strategies in administering of

surfactant

Prophylactic Surfactant administration

Rescue or Therapeutic Surfactant administration

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

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

Types of equipment needed

Administration equipments

Resuscitation equipments

Monitoring equipments

Dosing

Survanta, 4mL/kg

More Illustration will be here

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

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.

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 *)

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

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%.

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.

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.

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.

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 …..

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……….

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

CONTRAINDICATIONS

the presence of congenital anomalies

incompatible with life beyond the neonatal

period.

respiratory distress in infants with laboratory

evidence of lung maturity…………

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………

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

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………..

ADMINSTRATION OF

SURFACTANT WITHOUT MV

IN= INTUBATE

SUR= SURFACTANT IS ADMINISTERD

E= EXTUBATE

Any Q

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