Respiratory distress syndrome (RDS) in preterm infants/Neonates
Prophylactic and early surfactant administration
Later surfactant administration
O: Reduced mortality and pulmonary complications (Bronchopulmonary dysplasia-BPD and other)
Surfactant therapy involves intervention via various methods like oxygen, CPAP, mechanical ventilation, and surfactant. Many ask if surfactant therapy works. They also ask what is the ideal dose and when to administer the dose. Too much and too late could cause problems versus early with a low dose. When surfactant was introduced in neonatology, it reduced VLBW infant deaths by 30%. Surfactant use two decades ago also led to an 80% decline in neonatal mortality in the United States.
However, surfactant can fail and normally does so because of certain factors like when infants are extremely preterm and developed poorly structured longs and when there an infant develops perinatal asphyxia. When those factors are not present, surfactant reduces incidence of PDA, sepsis pneumonia, and most importantly, reduces the need for mechanical ventilation. When there is absence of surfactant, infants may present with high distending pressures, airway distortion/stretch, cellular membrane disruption that could lead to edema or hyaline membrane formation, and other complications. From here it could advance to higher pressures/FiO2 and then eventually BPD, barotrauma.
Prophylactic treatment of infants during the first fifteen minutes of life seems more effective than later treatment. However, not all infants that show signs of developing RDS develop the condition. Overtreatment, especially with higher doses could expose infants to adverse effects, needlessly. In fact, multiple doses of surfactant, which has been a treatment of choice shown in the majority of trials may not be as helpful as thought. While functional inactivation of surfactant may be the reason why multiple doses are recommended, early treatment at low dose could be the best option.
Increased use of exogenous surfactant therapy is a better option when using extubation to NCPAP because it lessens the need for mechanical ventilation. When combined with early surfactant replacement therapy application, it greatly diminishes the probability of complications. Effective ventilatory management consists of rapid weaning and extubation to CPAP. While surfactant can be costly, the overall reduction in hospital and ancillary charges warrant early use of it.
Prophylactic and early surfactant replacement therapy minimizes pulmonary complications and mortality in ventilated infants that suffer from RDS or respiratory distress syndrome when compared to...
Airway Pressure on Cardiovascular Performance HEART-LUNG CONNECTION The Influence of Mean Airway Pressure on Cardiovascular Performance Breathing, also known as pulmonary ventilation, is the basic connection between the heart and lungs (Williams & Whitney, 2006). The connection allows air between the lungs and the atmosphere and the exchange of gases between the air and the alveoli in the lungs. Body receptors can detect changes involved in the movement of air and the
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