Surfactant Replacememt Therapy
- 1. SRT Mohammed Al Nadhri RT Intern N3510675
- 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
- 6. Types of equipment needed Administration equipments Resuscitation equipments Monitoring equipments
- 7. Dosing Survanta, 4mL/kg More Illustration will be here
- 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………..
- 23. ADMINSTRATION OF SURFACTANT WITHOUT MV IN= INTUBATE SUR= SURFACTANT IS ADMINISTERD E= EXTUBATE
- 24. Any Q
- 25. Thank U