Surfactant therapy

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Surfactant therapy
Other namesSurfactant application, Surfactant replacement
Specialty Neonatology

Surfactant therapy is the medical administration of pulmonary surfactant that is derived from outside of the body. Pulmonary surfactant is a soap-like chemical synthesized by type II alveolar pneumocytes and is of various lipids (80% phospholipids, 5-10% cholesterol, and ~10% surfactant-associated proteins). This biological fluid reduces surface tension and lines the aqueous layer covering the alveolar surface of the lung. For more details, see Pulmonary surfactant. [1] [2] [3]

Contents

Surfactant therapy, or surfactant replacement therapy, is used in situations where there is not sufficient fluid covering the lung. The most common use is in premature neonates or babies born with respiratory distress syndrome. Conditions adult respiratory distress syndrome or Hyaline Membrane Disease are also sometimes treated with exogenously derived surfactant. One of the more common uses of surfactant therapy is to treat alveolar surfactant deficiency in premature newborns. Most commonly, treatment is composed of multiple doses of 100 mg/kg of exogenous surfactant. [2]

Types of Surfactants

Poractant alfa, Calfactant, and Beractant are types of natural surfactants commercially available in the United States. Although data is sometimes conflicting, it appears that there are no significant differences among the available preparations.[ citation needed ]

LISA surfactant delivery in infants

The LISA (Less Invasive Surfactant Administration) method is much more effective in situations where the preterm infant is already breathing, and it has become a standard procedure in German hospitals. [4] Intubation via mechanical ventilation is less effective than the LISA method within the first 72 hours of birth. [5]

Respiratory Distress Syndrome

Exogenous surfactant replacement therapy is effective in reducing IRDS mortality and morbidity in preterm infants. [6] [7] [8] [9]

Adult respiratory distress syndrome

Surfactant therapy is not used to treat adults with adult respiratory distress syndrome because the evidence regarding its effect on patient-important outcomes is inconsistent. As of 2019, there is no evidence showing that treatments with exogenous surfactants, statins, beta-blockers or N-acetylcysteine decreases early mortality, late all-cause mortality, duration of mechanical ventilation, or number of ventilator-free days. [10]

See also

References

  1. ↑ Possmayer, Fred; Zuo, Yi Y.; Veldhuizen, Ruud A. W.; Petersen, Nils O. (2023-12-13). "Pulmonary Surfactant: A Mighty Thin Film" . Chemical Reviews. 123 (23): 13209–13290. doi:10.1021/acs.chemrev.3c00146. ISSN   0009-2665. PMID   37862151.
  2. 1 2 Robertson, Bengt; Halliday, Henry L. (1998-11-19). "Principles of surfactant replacement" . Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease. 1408 (2): 346–361. doi:10.1016/S0925-4439(98)00080-5. ISSN   0925-4439. PMID   9813384.
  3. ↑ Dhar, Dipak Kumar; Majumder, Nilratan; Paul, Debasish (2016). "Assessment of Knowledge and Practice of Mothers of Children under Five regarding Zinc Therapy in Childhood Diarrhea" . International Journal of Advanced and Integrated Medical Sciences. 1 (4): 169–172. doi:10.5005/jp-journals-10050-10055. ISSN   2456-2726.
  4. ↑ Härtel, Christoph; Paul, Pia; Hanke, Kathrin; Humberg, Alexander; Kribs, Angela; Mehler, Katrin; Vochem, Matthias; Wieg, Christian; Roll, Claudia; Herting, Egbert; Göpel, Wolfgang (29 May 2018). "Less invasive surfactant administration and complications of preterm birth". Scientific Reports. 8 (1): 8333. Bibcode:2018NatSR...8.8333H. doi:10.1038/s41598-018-26437-x. PMC   5974027 . PMID   29844331.
  5. ↑ Lau, Christine S. M.; Chamberlain, Ronald S.; Sun, Shyan (24 March 2017). "Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants". Global Pediatric Health. 4: 2333794X1769668. doi:10.1177/2333794X17696683. PMC   5433666 . PMID   28540346.
  6. ↑ Suresh, Gautham K; Soll, Roger F (21 April 2005). "Overview of Surfactant Replacement Trials". Journal of Perinatology. 25 (S2): S40–S44. doi: 10.1038/sj.jp.7211320 . PMID   15861172.
  7. ↑ Fujiwara, Tetsuro; Chida, Shoichi; Watabe, Yoshitane; Maeta, Haruo; Morita, Tomoaki; Abe, Tadaaki (January 1980). "Artificial surfactant therapy in hyaline-membrane disease". The Lancet. 315 (8159): 55–59. doi:10.1016/s0140-6736(80)90489-4. PMID   6101413. S2CID   19170032.
  8. ↑ Liechty, Edward A.; Donovan, Edward; Purohit, Dilip; Gilhooly, Joseph; Feldman, Bernard; Noguchi, Akihiko; Denson, Susan E.; Sehgal, Sabitha S.; Gross, Ian; Stevens, Dennis; Ikegami, Machiko; Zachman, Richard D.; Carrier, Steven T.; Gunkel, J. Harry; Gold, Alan J. (1 July 1991). "Reduction of Neonatal Mortality after Multiple Doses of Bovine Surfactant in Low Birth Weight Neonates with Respiratory Distress Syndrome" . Pediatrics. 88 (1): 19–28. doi:10.1542/peds.88.1.19. PMID   2057268. S2CID   26067225.
  9. ↑ Kendig, James W.; Notter, Robert H.; Cox, Christopher; Aschner, Judy L.; Benn, Steven; Bernstein, Richard M.; Hendricks-Munoz, Karen; Maniscalco, William M.; Metlay, Leon A.; Phelps, Dale L.; Sinkin, Robert A.; Wood, Beverly P.; Shapiro, Donald L. (1 November 1988). "Surfactant Replacement Therapy at Birth: Final Analysis of a Clinical Trial and Comparisons With Similar Trials". Pediatrics. 82 (5): 756–762. PMID   3054783.
  10. ↑ Lewis, Sharon R.; Pritchard, Michael W.; Thomas, Carmel M.; Smith, Andrew F. (July 23, 2019). "Pharmacological agents for adults with acute respiratory distress syndrome". The Cochrane Database of Systematic Reviews. 7 (7) CD004477. doi:10.1002/14651858.CD004477.pub3. ISSN   1469-493X. PMC   6646953 . PMID   31334568.
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