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Interventions 2 (RESP 319) > Mod 13 Surfactent > Flashcards

Mod 13 Surfactent Flashcards

1
Q

When is Surfactant produced?

A

Produced at 24-34 (26) gestation

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2
Q

What produces Surfactant?

A

Type 2 Alveolar Cells

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3
Q

What is the main component of Surfactant?

A

Main lipid = dipallmitolyphosphatiylcholine (DPPC)

  • composed of phospholipids, lipids, and proteins
  • DPPC is the agent that decreases surface tension
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4
Q

Where is Surfactant stored?

A

Lamellar bodies in the cytoplasm of type 2 cells

  • 1000 mg/kg in term infants
  • 4-5 mg in preterm infants
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5
Q

What is the half life of surfactant?

A

5-10 hrs

  • 1/2 life = time it takes for the amount of a drugs active substance in your body to reduce by half
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6
Q

Can surfactant be recycled?

A

Yes, up 90% of DPPC recycled is reabsorbed into type 2 cells

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7
Q

What is exogenous surfactant?

A

outside the pts own body

  • external surfactant is used to replace deficient pulmonary surfactant of premises w/rds
  • Used to replace surfactant deficiency from outside the body
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8
Q

What is the recommended dose of Surfactant?

A

5 ml/kg given as 2 divided doses by direct tracheal instillation

  • can be repeated q12hrs an again q24hrs if needed
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9
Q

Aside from lipids, what is the protein composition in surfactant?

A

20% protein portion = SP-A, SP-B, SP-C, SP-D

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10
Q

split this into others later**

What is the composition and purpose of each protein portion in surfactant?

  • i.e SP-A etc. etc.
A

SP-A – high molecular weigh, water soluble glycoprotein – seems to regulate secretion and exocytosis of surfactant from the type II cell, and reuptake

SP-B and SP-C – low molecular weight, hydrophobic proteins – improve adsorbtion and spreading of the phospholipid throughout the air-liquid interface in the alveolus

SP-D – similar to SP-A – large, water soluble protein, molecular configuration is different. Unsure as to purpose, could be incorrectly labelled as surfactant specific protein.

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11
Q

What is Colfosceril Palmitate (Exosurf)/ synthetic Surfactant a risk of causing?

A

High risk of pulmonary hemorrhage

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12
Q

What is the goal of Surfactant replacement?

A

Lower surface tension and decrease the amount of pressure and inspiratory effort to re expand the alveoli during inspiration

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13
Q

What affect does Exogenous surfactant have on surface tension, compliance, and WOB?

  • what is the aim?
A
  1. Decreases surface tension
  2. Increase compliance
  3. Decrease WOB
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14
Q

Why can exogenous surfactant be recycled by the body?

A

Exogenous surfactant is taken back into type 2 cells and becomes the surfactant pool to go through the same recycling process that endogenous surfactant goes through

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15
Q

How many doses of exogenous surfactant is needed?

  • why?
A

1 or 2 doses bc it can be recycled into the body

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16
Q

Clinical indications for surfactant use? (7)

A
  • RDS prevention,
  • Rescue/retroactive treatment,
  • Prophylactic
17
Q

What are common Surfactants used in canada?

A

Bovine Lipid Extract Surfactant (BLES) and Beractant (Survanta)

18
Q

Why does BLES allow rapid distribution?

A

Bles has lower viscosity and high protein concentration.

19
Q

Composition of BLES?

A

Mixed with DPPC and agents to reproduce natural surfactant; contains:

  • 27 mg phospholipids/ml
  • SP-B and SP-C
  • Kept frozen, needs rewarding to room temp
20
Q

Indications for BLES? (4)

A
  • Rescue Tx of RDS (Confirmed by CxR requiring mech vent w/increasing O2 reps, than its ASAP)
  • Prophylaxis for infants < 27 weeks of age
  • Mod-Severe MAS
  • Oxygen deterioration
21
Q

Contraindication for BLES?

A

active pulmonary hemorrhage

22
Q

Recommended dose for BLES?

A

5 ml/kg by direct tracheal instillation

  • can be repeated 3 time within the first 5 days of life if needed
23
Q

Dose for Beractant (Survanta)

A

4ml/kg when using birth weight

24
Q

How is Beractant (survanta) different from BLES?

A

Made with bovine lung extract mixed with DPPC, Palmitic acid, and triplmatin.

  • its a modified version of bles basically
  • also contains surfactant specific proteins SP-B and SP-C
25
Q

Indications for Beractant (Survanta)?

A
  • Rescue Tx of infants with RDS
  • Infants w/RDS confirmed by CxR that are mech vented preferably before 8hrs of age
26
Q

Recommended dosage for Beractant (Survanta)

A

100 mg/kg by direct tracheal instillation

  • can be repeated no sooner than 6hrs after initial dosing if evidence of resp distress
  • max 4 doses
27
Q

What a is a primary concern that needs to be monitored after surfactant administration?

A

Barotrauma/volutrauma

  • Closely monitor pressure/volume on vents as FRC improves (less need to inflate lung decrease)
  • Improvements are significant and oxygenation and ventilation improves within mins to hours
28
Q

What are hazards and complications of surfactant therapy?
(5)

A
  • Increased lung compliance and FRC = high PaO2
  • Over ventilation and hypocarbia
  • Apnea
  • Pulmonary hemorrhage in <700g at birth
  • Obstruction during instillation and physically leading to desaturations and bradycardia?
29
Q

How can obstruction occur with surfactant treatment?

A

During instillation airway can get filled with debris or can physically get blocked with the fluid

  • can lead to desaturation and bradycardia
30
Q

How is Surfactant administered?

A

endotracheal tube

  • direct instillation with catheter or via side stream adapter
  • Multi access catheters can be used if pt is on mech vent (avoids manual ventilation)
31
Q

How much Surfactant should be delivered at a time?

A

1/4 of total volume over 3-4 aliquots

32
Q

Procedure of Surfactant administration ?

A

Add slides 3-4

33
Q

Physiologic effects of decreased surfactant

A

High ST forces causes

  1. increased ventilating pressures of the alveoli
  2. High pressures can cause barotrauma.
34
Q

Prophylaxis surfactant age?

A

<27wks

35
Q

Max day for BLES

A

Use up for 5 days, repeat up to 3 times

36
Q

Changes in lungs immediately post-surfactant?

A
  • Immediate pressure decrease
  • possible apnea
  • Improvement in oxygenation.
  • FRC improves
  • prevent volutrauma
37
Q

Hazards of surfactant use?

A
  • Increased compliance
  • Overventilation
  • Apnea
  • Pulmonary hemorrhage
38
Q
A

Interventions 2 (RESP 319) (25 decks)

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