Clasifcacin de SDRSe distinguen cuatro grados o tipos de gravedad creciente:Reticulado fno granulado del parnquima pulmonar, grado I; en algunospacientes es un moteado ms grueso (grados II y III), y en las formasclnicas ms graves, !ay una opacidad total de los pulmones (grado I")#$ %ipo I: patr&n reticulogranular fno y !omogneo como vidrioesmerilado#$ %ipo II: similar al anterior pero ms denso y con 'roncograma areoms visi'le#$ %ipo III: pacifcaci&n alveolar difusa y con(uente con menor volumenpulmonar#$ %ipo I": )pulm&n 'lanco*# +usencia prcticamente total de aire en elparnquima pulmonar, cuya densidadno sedistingue de la siluetacardaca#,rado -: ./0 con curso clnico leve#Se o'serva retculo granulado o esmerilado no intenso, en 'roncograma,si 'ien esta presente, no es muy ntido y la silueta cardaca tiene lmites'ien marcados, diferencindose del te1ido pulmonar,rado 2: ./0moderada, es decir difcultad respiratoria de mayorintensidad y requerimiento s de o3igeno ms elevados# /oteadogranulardifuso, pulmones)opacos*y'roncogramaareoesms ntido# 4a silueta cardiaca tiene 'ordes 'orrosos que no permitendelinear su contorno, imagen de )pulmon peque5o*# ,rado 6# ./0 grave#/oteado fno intenso que da una opacidad general del pulmon#7roncograma ntido resulta imposi'le distinguir la silueta cardiaca# 8ursoclnico grave#indicaciones para administracin de surfactanteProflctica: 9rematuro con riesgo de desarrollar S:R secundaria a defcienciade surfactante (menor a 62 S:, o peso al nacer ;-6e7born nursery )if a7aiting e:ternal transport to ;CI* ;nstitutions that ha3e the ability to perform neonatal resuscitation and stabili@ation procedures +ndicati%n' 1rophylactic administration may be indicated in 1remature infants at high ris8 of de3eloping RDS secondary to surfactant deficiency )e.g., J$! 7ee8s or lo7 birth 7eight J#,$"" g* ;nfants in 7hom there is laboratory e3idence of surfactant deficiency such aslecithinGsphingomyelin ratio J!#, bubble stability test indicating lung immaturity, or the absence of phosphatidylglycerol Rescue or therapeutic administration may be indicated in preterm or full-term infants 7ho are suspected of ha3ing surfactant deficiency by inacti3ation and Who re9uire endotracheal intubation and mechanical 3entilation secondary to respiratory failure and Who re9uire an fraction of inspired o:ygen )%;5!* K".4", and Clinical and radiographic e3idence of neonatal RDS or MAS, including >eonates 7ith mean air7ay pressure L, cm ?!5 to maintain an ade9uate partial pressure of o:ygen )1a5!*, arterial o:ygen saturation, or blood o:ygen saturation )Sp5!*. Surfactants may be used as a 3ehicle to deli3er other drugs such as antibiotics, anti-inflammatory agents, and bronchodilators. 1ostoperati3e de3elopment of acute respiratory distress syndrome )ARDS* follo7ing cardiac surgery. 2he use of e:ogenous surfactant reduces time on positi3e-pressure3entilation and reduces the ;CI and hospital stay. 2reatment of se3ere respiratory syncytial 3irus-induced respiratory failure 7ith porcine surfactant may impro3e gas e:change and respiratory mechanics and shorten the duration of in3asi3e mechanical 3entilation and hospital stay. C%ntraindicati%n'Relati3e contraindications to surfactant administration are 2he presence of congenital anomalies incompatible 7ith life beyond the neonatal period Respiratory distress in infants 7ith laboratory e3idence of lung maturity Diagnosis of congenital diaphragmatic hernia. 2he congenital diaphragmatic hernia study group enrolled !,$,+ patients into their registry and found that early use of surfactant )J# hour post birth* did not alter the odds ratio, 7hen compared 7ith the no surfactant group, and those 7ith immediate distress recei3ing surfactant had greater odds of death than the group 7ho did not recei3e surfactant. %urthermore, it is also plausible that administration of surfactant may cause a clinical deterioration in infants 7ith substantial pulmonary hypoplasia, although further randomi@ed controlled trials are needed to confirm. 1atient hemodynamically unstable Acti3e pulmonary hemorrhage 8a4ard'*C%mplicati%n' 1rocedural complications resulting from the administration of surfactant include 1lugging of . MacArthur Bl3d., Ste. #"", ;r3ing, 2O ,'"+$.A/aila$ility %f C%mpani%n )%cument' 2he follo7ing is a3ailable Restrepo RD. American Association for Respiratory Care )AARC* clinical practice guidelines from Ereference-basedE to Ee3idence-based.E Respir Care. !"#" Aun&'')+*,(,-/. A3ailable in 1ortable Document %ormat )1D%* from the American Association for Respiratory Care )AARC* Web site. 1rint copies A3ailable from the American Association for Respiratory Care )AARC*, /4!' >. MacArthur Bl3d., Ste. #"", ;r3ing, 2O ,'"+$.0atient Re'%urce' >one a3ailableNGC Statu' 2his summary 7as completed by o3ember $", #//(. 2he information 7as 3erifiedby the guideline de3eloper on December #', #//(. 2his >6C summary 7as updated by