Surfactant is a surface acting material or agent that is responsible for lowering the surface tension of a fluid. Surfactant that lines the epithelium of the alveoli in lung is known as pulmonary surfactant & is decreases the surface tension on the alveolar membrane. Presented by Dr. Samad

2. Surfactant
Surfactant is a surface acting material or agent
that is responsible for lowering the surface
tension of a fluid. Surfactant that lines the
epithelium of the alveoli in lung is known as
pulmonary surfactant & is decreases the
surface tension on the alveolar membrane.

3. Stages of lung development

4. Source of secretion of pulmonary surfactant :
Pulmonary surfactant is secreted by two types of
cell :
o Type II alveolar epithelial cells in the lungs ,
which are called suefactant secreting alveolar
cell or pneumocytes.
o Clara cells which are situated in the
bronchioles

7. Exogenous Surfactant Therapy
Pulmonary surfactant is necessary for normal
lung function throughout postnatal life.
administration of surfactant to surfactant
deficient newborn, decreases the minimum
pressure required to open the lung, increases
the maximum lung volume and prevents lung
collapse at low pressure.

8. History of surfactant
• 1956 JA Clements – role of
surfactant in alveolar stability
• 1959 M.E Avery & J. Mead : RDS in
premature babies is due to
surfactant deficiency
• 1962 J.A Clements : Identification
of DPPC
• 1972 J.A Clements & J.R King :
identification of surfactant
proteins.

9. • In 1980, Fujiwara et al. performed
treatment via the respiratory tract in
10 pediatric patients with RDS, using
Surfactant. This was the first successful
treatment using artificial PS
supplementation in humans.

10. • This therapy has been further developed in
the treatment of RDS, which was previously
limited to conventional oxygen therapy,
artificial ventilation therapy, and other
symptomatic therapies. It was the first time
that a treatment method of complementing
PS with artificial preparations was used, which
was a milestone in this field.

11. • Surfacten® was first marketed in Japan in 1986
as the world's first artificial PS replacement
therapy for neonatal RDS and, since then,
many other similar products have been
developed.

12. Composition of surfactant

14. Function of pulmonary Surfactant
• Lower surface tension at air-liquid interface
• Protects patency of small airways
• Prevents movement of the fluids into the
alveolus
• Enhances mucous clearance
• Stimulate lung host defense system

15. Indication
Prevention & treatment of RDS in premature
infants
Intubated infants requiring more than 40%
oxygen
Other uses :
Meconium aspiration syndrome
Congenital diaphragmatic hernia
neonate with severe respiratory failure

16. Timing of surfactant administration
• Prophylactic surfactant therapy, which is
administered within 15 minutes of delivery to
infants at risk of RDS.
• Early rescue surfactant therapy which is
administered by two hours of age with sign
symptom of RDS , frequently before the
diagnosis of RDS.
• Late Rescue surfactant therapy which is given
once the diagnosis of RDS is established.

17. Doses formulation of Exogenous Surfactant

18.  Natural Surfactant:
 Beractant (Survanta): (25mg/ml)
Bovine lung extract.
Dose: 4 ml/kg via endotracheal tube q 6 hours;
4 doses.

19.  Poractant alfa (Curosurf): (120mg/1.5ml)
Porcine lung extract.
Dose: 2.5 ml/kg via endotracheal tube q 12
hours; 1-2 doses.

20. Synthetic Surfactant:
Colfosceril Palmitate (Exosurf) (67.5mg/5ml):
5 ml/kg via endotracheal tube q 12 hours; 2-4
doses.

21. Modes of surfactant administration
• Bolus administration
– One dose: complete dose given within a single
time frame
– Multiple doses: total dose divided into two or
more amounts (aliquots) and given separately
in time
• Continuous infusion (slow administration of the
surfactant preparation)
• Nebulization: suspension of aerosolized
surfactant that is subsequently inhaled

22. When rapid bolus infusions were compared with slow
bolus or continuous infusions in several animal
studies, they were noted to be superior in terms of
overall distribution of the surfactant and a faster rate
of improvement of oxygenation and lung compliance .
However, side effects, such as transient bradycardia
and decreased blood pressure, were noted with rapid
bolus administration. At present, the rapid bolus
technique remains the recommended method of
surfactant administration.

23. Equipments Required
• Laryngoscope handle &
blade
• Suction tube 5FR
• AMBU bag and mask
• ETT & fixator
• LISA catheter
• Syringe
• Stethoscope
• Ventilator
• Drugs : Surfactant,
Atropine

24. Multichannel ET tube LISA cather

25. Procedure
• Sufficient, appropriately trained person carrying
out the procedure.
• Use video laryngoscope where available
• LISA catheter inserted through cords to desired
length
• Note length at lips to ensure catheter remains in
same place throughout procedure
• Remove laryngoscope holding catheter in place
• Hold mouth closed

26. • Administer surfactant slowly over 3-5 minutes.
Further slow administration if apnoea or
bradycardia occur
• Titrate oxygen as required
• Atropine if persistent bradycardia
• Naloxone if apnoeic or shallow breathing
despite stimulation
• Intubate if prolonged apnoea, bradycardia or
hypoxia.

28. Complications
• Oxygen desaturation
• Bradychardia
• Hypotension
• Pneumothorax
• Pulmonary hemorrhage
• Leakage of surfactant

29. Outcome
Short term outcome :
Reduce deaths from RDS
Decreases Air leaks
Decreases oxygen & ventilatory requirements
Long term outcome :
Decrease rate of severe disability or death

30. Contraindication
• Acute pulmonary haemorrhage
• Patient haemodynamically unstable
• Respiratory distress in infants with laboratory
evidence of lung maturity
• Presence of congenital anomalies incompatible
with life beyond the neonatal period.

31. Surfactant given to a patient
• Name- baby of tamanna
• MOD – delivered by LUCS @ 32wks of
gestation @hospital due to PIH with BOH(3
neonatal death) with history of previous 2
LUCS.
• Birth weight -1.9kg
• Chief complaints – Respiratory distress since
birth

32. X-ray of Pre & Post surfactant therapy