RDS and Surfactant Therapy RDS Improvements in outcome
- Slides: 26
RDS and Surfactant Therapy
RDS Improvements in outcome due to: l Antenatal steroids l Early postnatal surfactant therapy l Gentler ventilation techniques 2
Risk Factors l Prematurity l Males l Second born twins l Infants born by c-section l Caucasian race l Maternal diabetes l Asphyxia 3
Sequelae of RDS l Intraventricular hemorrhage l Periventricular leukomalacia l Bronchopulmonary dysplasia l Patent ductus arteriosus l Pulmonary hemorrhage 4
Decreased Incidence of RDS l Use of antenatal steroids l Pregnancy-induced or chronic maternal hypertension l Prolonged rupture of membranes l Maternal narcotic addiction 5
Secondary Surfactant Deficiency l Intrapartum asphyxia l Pulmonary infections l Pulmonary hemorrhage l Meconium aspiration syndrome l Oxygen toxicity/barotrauma/volutrauma 6
Role of Surface Tension in Pulmonary Function l Surfactant reduces surface tension at air-fluid interface l Improves lung compliance l La. Place equation P = 2 T r l Contains hydrophobic groups (tails) and hydrophilic groups(heads) and forms monolayer 7
Compliance Maximal volume Volume Pressure Opening pressures 8
Surfactant Deficiency l Surfactant deficiency = decreased compliance l Decreased compliance = alveolar collapse and loss of FRC l Loss of FRC = V/Q mismatch l V/Q mismatch = desaturation, and respiratory distress 9
Composition of Pulmonary Surfactant 10
Surfactant Metabolism Lamellar bodies Synthesis Secretion Alveoli Recycling Clearance 11
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Antenatal Steroids Decrease RDS Gest. age Rate of RDS without steroids Rate of RDS with Steroids <30 weeks 60% 35% 30 -34 weeks 25% 10% >34 weeks 5% 5% 13
Effects of Corticosteroids on Surfactant Synthesis l Increase surfactant phospholipids l Increase CP-cytidyltransferase activity l Increase fatty-acid synthase activity l Increase surfactant proteins gene expression l Induce ion and water transport proteins 14
Surfactant Therapy for RDS Significant reduction in: l Mortality l Pneumothorax Unaltered: l Bronchopulmonary dysplasia l Intraventricular hemorrhage l Sepsis l Patent ductus arteriosus 15
Surfactant Therapy for RDS Decreases mortality l Greatest benefit when used with antenatal steroids l Improvement in compliance, functional residual capacity, and oxygenation l Reduces incidence of air leaks l 16
Surfactant Therapy For RDS l Natural protein-containing preparations show a faster therapeutic response l Major surface lowering component: phosphatidylcholine l Retreatment mostly required in severe RDS 17
Surfactant Replacement Therapy l Administer less than 2 hours after birth l Consider delivery room use in infants < 1000 grams l Most infants require 2 doses 18
RDS-clinically Non-specific findings of respiratory distress: • Grunting • Flaring • Retracting • O 2 requirement 19
RDS-radiography • Diffuse reticular granular or • “ground glass”pattern • Air bronchograms • Underaeration 20
Mild RDS 21
Moderate RDS 22
Severe RDS 23
Pulmonary Interstitial Emphysema 24
Pneumothorax 25
Treatment l Surfactant administration if intubation required. l CPAP to prevent atelectasis l CPAP as adjunct following surfactant administration l Blood gases: p. H of 7. 25 -7. 4 PCO 2 of 40 -65 mm Hg Pa. O 2 of 50 -70 mm Hg 26
- Shampoo formula
- Pulmonary surfactant function
- List of surfactants and hlb values
- Surfactant
- Surfactant
- Seromucous glands
- Bronchioles
- Type 2 pneumocytes secrete
- Soy lecithin hlb
- Subclavian lymph trunk
- Pediatric physical therapy outcome measures
- Improvements & betterments
- Medicare improvements for patients and providers act
- What improvements have been made to kevlar
- Allied home improvements
- Offsite improvements
- Improvements roadmap
- Direct improvements
- Psychodynamic and humanistic therapies have in common
- Bioness bits cost
- Psychoanalytic therapy is to as humanistic therapy is to
- Silverman score
- кагами-огата
- Pnuemothorax xray
- Openstack rds
- Rds rightsizing
- Initinib