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Neonatal Pharmacology > Pulmonary Surfactant > Flashcards

Pulmonary Surfactant Flashcards

1
Q

When was Surfactant discovered?

A

1920’s

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2
Q

When was the Significance of Surfactant discovered?

A

End of the 1950’s (surfactant deficiency RDS)

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3
Q

What is surfactant?

A

A surface-active lipoprotein complex formed by Type II Alveolar cells

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4
Q

Surfactant lines the _______ and the smallest __________.

A

Alveoli

Bronchioles

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5
Q

Surfactant is produced during the _________ ____ stage of lung development (17-26 wks)

A

Terminal sac stage

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6
Q

Term infants have a storage pool of approximately _____ mg/kg of surfactant.

Pretermers have ___-___ at birth.

A

100 mg/kg

4-5 mg/kg

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7
Q

Alveolar surfactant can be both broken down by __________ and/or reabsorbed into the __________ structures of the Type II cells

A

Marcrophages

Lamellar

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8
Q

Up to ___% surfactant is recycled from the Alveolar space in the NB

A

90%

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9
Q

What 3 factors negatively effect Surfactant quality & production

A
  1. Hyperinsulinism
  2. Acidosis
  3. MAS (chemical pneumonitis is the probable culprit)
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10
Q

What are the 5 functions of surfactant?

A
  1. Increases Pulmonary compliance
  2. Reduces surface tension
  3. Facilitates recruitment of collapsed airways
  4. Protection of the pulmonary epithelium
  5. Prevents Atelectasis at the end of expiration
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11
Q

What is compliance?

A

The ability of the lungs & thorax to expand

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12
Q

What is water surface tension?

What is lung surface tension?

A

70 Dynes/cm

25 Dynes/cm
*but at end of expiration, compressed surfactant phospholipid molecules decrease surface tension very low (near 0)

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13
Q

Surfactant allows lungs to inflate more _______ and _______ WOB

A

easily

Decreases

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14
Q

Studies of exogenous surfactant administration–>______increase oxygenation and rapid decrease in degree of _________ _____ support required.
Also increased _____ & followed by slower & variable _______ in lung compliance. Also ______in V/Q mismatch.

A

rapid
mechanical vent

FRC
Increase
Decrease

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15
Q

As the _______ increase in size, the ________ becomes distributed.

This also helps all _______ expand at the same rate.

A

Alveoli
surfactant

Alveoli

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16
Q

Keeping airways _____ is very important.

A

dry

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17
Q

By reducing surface tension with Surfactant, the fluid from ________ is not drawn into the alveolar spaces.

What happens without Surfactant?

This keeps the airways ____

A

capillaries

Surface tension forces draw fluid from the capillaries to the Alveolar spaces

Dry

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18
Q

What is the composition of Surfactant?

A

~40% DPPC (phospholipid-strongest molecule)
~40% other phospholipids (PC)
~5% surfactant-associated proteins (SP-A, B, C, & D)
Cholesterol (neutral lipids)
Traces of other substances

19
Q

What is the strongest surfactant molecule in pulmonary Surfactant mixture?

A

Dipalmitoylphosphatidylcholine

DPPC

20
Q

Name 3 Dz’s r/t Surfactant Deficiency

A
  1. RDS
  2. Congenital Surfactant Deficiency
  3. Pulmonary Alveolar Proteinosis
21
Q

Name 3 other Dz’s you may see Surfactant used

A
  1. MAS-Mec inhibits surfactant fxn–> Alveolar collapse. Chemical pneumonitis & acidosis can also have negative effects.
  2. Pulmonary Hemorrhage
  3. Pneumonia
    (not routine use in the above 2–efficacy is not certain)
22
Q

Name the 3 types of Surfactants

A
  1. Synthetic Surfactant
  2. Animal-Derived Surfactant
  3. Human Amniotic Fluid-Derived Surfactant
23
Q

Which type of Surfactants are used the most?

A

Animal-Derived Surfactant

24
Q

What is the name of the Synthetic surfactant?

A

Exosurf–can be w/or without protein components

25
Q

What are the names of the 3 Animal-derived Surfactants?

What are they produced from?

A

Curosurf—minced pig lung

Infrasurf—calf lung lavage fluid

Survanta—minced cow lung w/additional DPPC, palmitic acid and tripalmitin

26
Q

Has human-derived surfactant undergone clinical trials?

Is it in use in clinical practice?

A

Yes

No

27
Q

What is the administration technique for Surfactant?

A

ETT

28
Q

What method of administration is promising in the future?

A

LMA

  • *needs to be studied in large, randomized trial
  • *& LMA’s are only avail >1500 gms
29
Q

T/F: Surfactant could be used for Re-treatment w/signs of worsening or persistent RDS.

A

True

30
Q

A Low/High threashold for peak dosing should be used for babies w/RDS who have perinatal depression or infection.

A

Low threashold for peak dosing

31
Q

Surfactant is ________ metabolized. There is some _______ _________ of surfactant d/t action of soluble proteins and other factors in the small airways & alveoli.
What may be required?

A

Quickly
Functional Inactivation

Subsequent doses

32
Q

What does Meta-Analysis of Surfactant studies show?

A

Decreased risk of pneumothoraces w/multiple-dose Surfactant therapy (practice & pt dependent)

33
Q

What should be monitored when giving Surfactant?

A
  • ETT patency and position
  • O2 sats, EKG, B/P (watch for post-dose hyperoxia, hypocarbia, & over-ventilation)
  • Blocked airway
34
Q

Use Surfactant in what type of setting?

A

Highly supervised clinical settings w/immediate availability of clinicians w/experience w/intubation, ventilation management, & general care of preterm infants.

35
Q

When should dosing of Surfactant be slowed or halted?

A

If dusky, aggitated, HR slows, SpO2’s decrease 15% or more, or surfactant backs up into ETT.

36
Q

Name the adverse effects/precautions for Surfactant

A
  1. Reflux of surfactant up the ETT
  2. Oxygen desaturation (r/t transient hypoxemia & bradycardia)
  3. Pulmonary hemorrhage (2-4%, smallest pts w/untx’d PDA d/t rapid fall PVR–>increased pulmonary blood flow)
  4. Post dose hyperoxia, hpocarbia and/or overventilation–>possible pnuemo
37
Q

Are you likely to see adverse effects/precautions in practices used to using Surfactant?

A

No

38
Q

There is increased risk of death and short-term morbidity r/t what adverse effect of Surfactant?

A

Pulmonary Hemorrhage

39
Q

Studies show increased liklihood of hemorrhage r/t which surfactant product?

A

Animal vs. Synthetic

40
Q

What might you need to give after Surfactant is given?

A

Increased FiO2 or vent settings (i.e. MAP)

41
Q

Has the rate of IVH fallen since the use of Surfactant?

A

No consistent effect on IVH has been observed.

42
Q

Animal-derived surfactant has specific proteins that aid in __________ _______ and resist _________ ____________

A

surfactant absorption

Surfactant inactivation

43
Q

Animal-derived surfactants have more rapid ______ of action

A

onset

44
Q

Animal-derived surfactants should be favored in clinical situations because of greater ________ than synthetic surfactants

A

benefits

Neonatal Pharmacology (17 decks)

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