This document discusses exogenous surfactant therapy for preterm infants. It provides guidelines on its use, including:
- Natural surfactants are preferred over synthetic versions.
- Prophylactic use within 15 minutes of life or rescue therapy improves outcomes like mortality and pneumothoraces.
- Multiple doses may be more beneficial than a single dose due to transient response and functional inactivation.
- Combining antenatal steroids and postnatal surfactant therapy has synergistic benefits and reduces mortality and morbidity.
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
Surfactant therapy |medical administration of exogenous surfactantNEHA MALIK
Surfactant therapy is the medical administration of exogenous surfactant. Surfactants used in this manner are typically instilled directly into the trachea. When a baby comes out of the womb and the lungs are not developed yet, they require administration of surfactant in order to process oxygen and survive.
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
Surfactant therapy |medical administration of exogenous surfactantNEHA MALIK
Surfactant therapy is the medical administration of exogenous surfactant. Surfactants used in this manner are typically instilled directly into the trachea. When a baby comes out of the womb and the lungs are not developed yet, they require administration of surfactant in order to process oxygen and survive.
Respiratory physiology & Respiratory Distress syndrome in a newborn.Sonali Paradhi Mhatre
Hi guys, This ppt shows the pathophysiology of pulmonary surfactant in newborn and respiratory distress syndrome. Main focus is towards management of RDS esp. exogenous surfactant administration. Your comments are welcome. Thank you.
CLINICAL TEACHING ON BUBBLE CPAP: Introduction, Definition, History of development, Physiology of Bubble CPAP, Principle, Patient interface, equipments for bubble CPAP, indication and contraindication for bubble CPAP, essential of CPAP, CPAP machine, bubble cpap machine application, setting pressure, FiO2, oxygen flow, Monitoring adequacy and complications of bubble CPAP, Monitoring infant condition, weaning for Bubble CPAP, CPAP Failure, complications related to CPAP, Preventing complications, Nursing Care.
Respiratory physiology & Respiratory Distress syndrome in a newborn.Sonali Paradhi Mhatre
Hi guys, This ppt shows the pathophysiology of pulmonary surfactant in newborn and respiratory distress syndrome. Main focus is towards management of RDS esp. exogenous surfactant administration. Your comments are welcome. Thank you.
CLINICAL TEACHING ON BUBBLE CPAP: Introduction, Definition, History of development, Physiology of Bubble CPAP, Principle, Patient interface, equipments for bubble CPAP, indication and contraindication for bubble CPAP, essential of CPAP, CPAP machine, bubble cpap machine application, setting pressure, FiO2, oxygen flow, Monitoring adequacy and complications of bubble CPAP, Monitoring infant condition, weaning for Bubble CPAP, CPAP Failure, complications related to CPAP, Preventing complications, Nursing Care.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
7.
Odds of death in hospital for VLBW infants
were reduced by 30 % after surfactant was
introduced.
80% of decline in the U.S. neonatal mortality
rate between 1989 & 1990 could be attributed
solely to the use of surfactant.
NEJM May 1994
8. Exogenous surfactant replacement has been
established as an appropriate preventive and
treatment therapy for prematurity-related
surfactant deficiency
(AMERICAN ACADEMY OF
PEDIATRICS
Committee on Fetus and Newborn March 1999, pp
684-685)
9. Indian Experience
The mean duration of ventilation 44.1 hours
lesser, and the hospital stay 4.37 days lesser in
babies who received surfactant.
The incidence of sepsis, pneumonia, PDA, IVH
and CLD was lower in babies who received
surfactant.
Narang et al Indian Pediatrics 2001
12. •Comparative trials demonstrate greater early
improvement in the requirement for ventilator
support, fewer pneumothoraces, & deaths
associated with natural surfactant.
•Natural surfactant may be associated with an
increase in IVH, though the more serious
hemorrhages (Grade 3 and 4) are not increased.
• Despite these concerns, natural surfactant extracts
would seem to be the more desirable choice when
compared to currently available synthetic
surfactants.
Cochrane 2005
14. •The animal surfactants have phospholipid compositions similar to
that of natural surfactant; they contain some SP-B and SP-C, but
no SP-A.
• The surfactant approved for use in the United States is Survanta
(beractant, Ross Laboratories, Columbus, Ohio) prepared by
mincing bovine lungs in saline and extracting the lipids, SP-B, and
SP-C with organic solvents. Dipalmitoylphosphatidylcholine,
palmitic acid, and triglyceride are then added to improve the
surface properties of the extract
•. The surface properties of organic-solvent extracts of lung tissue
also can be improved by removing neutral lipids by
chromatography, as is done with Curosurf
15. Absence of Surfactant
High Distending Pressures
What happens ?
Airway Stretch / Distortion
Cellular Membrane Disruption
Edema / Hyaline Membrane Formation
Higher FIO2 / Pressures
Barotrauma, BPD
19. •There is no indication that exogenously administered
surfactant inhibits the synthesis and secretion of
endogenous surfactant
•Two major benefits result from surfactant treatment:
- The biophysical effects of the surfactant on the
surfactant-deficient lungs
- And the provision of phospholipids as substrate
for recycling pathways
21. The meta-analysis (50 RCT) indicated
that there would be two fewer
pneumothoraces and five fewer deaths
for every 100 babies treated
prophylactically with surfactant.
22. •Prophylactic treatment during the first 15 minutes of life
appears to be more effective
•BUT not all infants that would appear to be at risk of
developing RDS, actually develop the condition.
•May lead to some infants being over treated, and possibly
being exposed to adverse effects, unnecessarily.
23. Trade name
Active
ingredient
Source
dosing
Survanta
Beractant
Bovine lung
extract
4ml/kg, maximum upto 4
times 6 hrly
Infasurf
Calfactant
Calf lung
lavage
3ml/kg, maximum up to 3
doses 12 hrly
Curosurf
Poractant alfa
Porcine lung
extract
2.5ml/ kg 1st dose
maximum upto 1.25ml//kg
up to 2 doses 12hrly
Neosurf
Beractant
Bovine lung
lavage
5ml/kg 1st dose maximum
upto 3 doses 12hrly
25. •Multiple doses of surfactant have been given in most
trials because the response to an individual dose is often
transient.
• In preterm animals, exogenously administered surfactant
is can be inhibited by soluble proteins and other factors in
the small airways and alveoli.
Multiple doses are thought to be useful because they can
overcome this functional inactivation of surfactant.
Pediatrics 1991
26.
27. Synergistic effect
Prenatal steroids + Surfactant is better
than either alone
↓ neonatal mortality
↓ air leaks
Give both
↓ severe IVH
Am J Obst Gynec Suppl, 1995
28.
A secondary analysis of data from
surfactant trials also indicates a greater
reduction in disease severity in babies
who received antenatal steroids
(evidence level 4).
Combination of antenatal steroids is
more effective than exogenous
surfactant alone (evidence level 2b).
29. INSURE procedure
Early surfactant replacement therapy with
extubation to N CPAP compared with continued
mechanical ventilation with extubation is
associated with a reduced need for mechanical
ventilation and increased utilization of exogenous
surfactant therapy.
COCHRANE 2005
30. “ Options for ventilatory management that
are to be considered after surfactant
therapy include very rapid weaning and
extubation to CPAP (grade B evidence).”
35. WHAT ARE THE RISKS OF EXOGENOUS SURFACTANT
THERAPY?
36. The short-term risks of surfactant replacement therapy
• Bradycardia and hypoxemia during instillation,
• Blockage of the endotracheal tube
• Increase in pulmonary hemorrhage following surfactant
treatment
• However, mortality ascribed to pulmonary hemorrhage
is not increased and overall mortality is lower after
surfactant therapy.
38. Surfactant is expensive
22% reduction in hospital charges per survivor
52 % Reduction in ancillary charges
39. Extremely preterm infants with structurally lung
immaturity
Pneumonia or pulmonary hypoplasia
Perinatal asphyxia
Pulmonary edema from lung damage or fluid
overload
Pulmonary edema from L-R shunting through PDA
Congenital B protein deficiency
Editor's Notes
Thanks m for explaining us the physiology in detail…moving on to the next part of presentation….as already introduced rds is a big prob in preterm babies and the risk exponentially rise with decreasing gestation…as much as that 80% of babies below gestation 27 weeks may land into rds…
So what are the interventions avaible….starting with basics of essential newborn care including the the temp management fluid and elctrolyte calculation along with managing oxygenation and ventilation constitutes the management of respiratory destress syndrome previously called as hmd….many of them will do fine with simple intervention mentioned…some will require cpap and some might require advance therapies like surfactant therapy………this presentation focuses on the surfactant therapy in rds…
The first and formost question is does it work…what is the proper timing to give …..which type whether natural or synthetic….how many doses…then we will be discussing what is the methodology
If we search neonatal databases maximum rcts in neonatalogy are attributed to surfactant therapy ….most of the systemic reviews and metaanylysises gives us good strength in answering the questions I put in the first slide
In may 1994 NEJM published a very significant data which concluded that
Within 5 years of the previous publication aap labaled exogenous surf therapy as standard preventive and therpeutic modality of management in case of prematurity related surf def..in front of u on the screen is the statement issued by commete on fetus and newborn….
So what is the indian status the first case controll study came in 2001 by narang which concluded that both the duration of ventilation and hospital stay reduced significantly in treated patients,…..secondly the complication which are in fact more with prematurity where also found to be reduced which was attributed to the overall respiratory well being of these patients…..this was one of the first kind of studies which prooved cost effectiveness of surfctant despite the critisism in our country….
Pramarily of two types the natural ones these are the Animal lungs extracts and the sunthetic one..what intersts us here is the natural one.. I ll be discussing this over next few slides…The natural ones are prepared from variety of animals..from bovine its called as survanta…calflung its called exosurf and porcine called as curosurf….
Lets see what the databse says about tis…In 2005 cochrane stated that natural surfactant decreases ventialtoty requirement and also other complication….. Although it increases chance of IVH but if compared to the currently available synthetic product they are all the way superior
So cochrane came with final conclusion that ……
Lets try to underastand this on pv loop If we compare the efficacy of available surfactants here on this pv curve it clearly seems that the lower opening pressure required are much less with natural surfactant …further if we compare the opening pressures amongst natural one sheep extract scores highest in efficacy….we in our unit use cursosurf whose efficacy lies between sheep extract and survanta…..
Before proceding further Lets us briefly understand what happens in rds
This is simple digram depicting alveoli with deficient surfactant because the surface tension working inside the alveoli, the alveoli tend to collapse….because of surfactant in alveoli the collapsibility decreases….
This small video explain the physiology..i don’t know its visible properly…coin is floating over water because of surface tension..now if we administer surf…the air liquid interface breaks and coin sinks…..
If we try to understand this on respiratory mechanics it will look like this…This is pressure volume loop showing difference between rd lung and normal lung…if we see the lower opening pressure in rds its 15..its less than 10 somewhere here…if u see the change in volume with pressure there is exponential rise and exponential decay in normal lung while its very very poor in hMD…..as we all know minute ventilation is a basic of respiratory function…..
Now the last querry which chalanges the usefullness is whether surf interfers with the normal physiology answer is no….surf do not inhibit the synthesis of endogenous surf……in fact not only surf has postive effect on lung mechanics it also gets recycled in making of natural surf
Timing of surf administration emerged as single most important factor as for as the outcome of rds is concerned….administering the surfactant within two hours of birth as a matter of fact in labour room itself is called as prophylactic therapy…….these patients are identified as at risk of RDS depending on gestation and then selected for prohylactic therapy (jusifiable in 27 weeker where incidence is very very high)…another form is administering surf once the signs and symp develop or after radiological cinfirmation this is called as rescue therapy…….this is further divided in early and late rescue depending upon the timin after disgnosis….
So what the database has to asy about this…The metanalysis done from pooled data of 5o rct revealed that there will be less comlication and less death with prohylactic therpy….although this is an establisted fact that prophylaxis is better than rescue I want to bring to an attention some practical problems with prophylaxis therapy…..lets se
What are the facts regarding ……..We had the twins one developed rds another remained stable
Before we procede to actual procedure I want to emhasis the importence of antenatal steroids…eventhogh we have a novel drug with us now we should never forget the importence of an steroids as cornerstone in preventing occurrence and severity of rds. Its been 100 year eve more an steroid still hold their position
……the established facts are
What was done next on this baby was something called as INSURE protocol…..it says….so we follows exactly the same…..
Lets see what the evidence has to say….it says that
This is our baby which was extubated within 4 hours of surf therapy…baby was put on buble CPAP and then further weaned to oxygen by hood and with good supportive therapy we were able to discharge this baby on …day of her life
Coming to the last part of discussion…its time to duscuss the problems of surfactant administartion
Increase in ph as compares to normal term subjects….If u compare wit incidence of ph in preterm itself its very less…on the contrary by preventing the complication of prematurity its actually reduces the incidence of ph
Surf is expensive yes its true….1.5 ml of surf cost arround 12000 however it should alwys be kept in mind that
This was already prooved in mumbai based study of narang
Yes first and foremost thing is the skills…monitoring ventilatory strategy and supportive therAPY….most important in surf therapy is insure…what are the other things ……