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surfactant


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Guest mmerocru

Please. We are using MIST or LISA, since a year. Does anybody use 200 mg/kg of surfactant with this way of surfactant administración? We started at 100 mg/ kg, but now we are thinking about 200 mg/ kg. What do you think? Thank you.

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Guest mmerocru

We too in bolus 2-3 min. Body lying flat and head/nose straight up.

But..what about dose???

 

 

Here you have some literature, nashwa:

Less Invasive Surfactant Administration (LISA) — Ways to deliver

surfactant in spontaneously breathing infants

Egbert Herting ⁎

Children's Hospital, University Hospital

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Minimally-invasive surfactant therapy in preterm

infants on continuous positive airway pressure

Peter A Dargaville,1,2 Ajit Aiyappan,1,3 Antonio G De Paoli,1 Carl A Kuschel,3,4,5

C Omar F Kamlin,3,4,5 John B Carlin,6,7 Peter G Davis3,4,5

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------

 

Pediatrics 2013;131;e502; originally published online January 28, 2013;

H. Gozde Kanmaz, Omer Erdeve, F. Emre Canpolat, Banu Mutlu and Ugur Dilmen

Randomized Controlled Trial

Surfactant Administration via Thin Catheter During Spontaneous Breathing:

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

 

Avoidance of mechanical ventilation by surfactant

treatment of spontaneously breathing preterm infants

(AMV): an open-label, randomised, controlled trial

Wolfgang Göpel*, Angela Kribs*, Andreas Ziegler, Reinhard Laux, Thomas Hoehn, Christian Wieg, Jens Siegel, Stefan Avenarius,

Axel von der Wense, Matthias Vochem, Peter Groneck, Ursula Weller, Jens Möller, Christoph Härtel, Sebastian Haller, Bernhard Roth,

Egbert Herting, on behalf of the German Neonatal Network

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  • 2 weeks later...
Guest drharry

We use Curosurf at most of centres in UK. Curosurf has been shown to be superior to Survanta –as it acts more rapidly and may improve survival at 36 weeks post conceptual age. Survanta also requires larger volumes to be given via the ETT and is therefore associated with more difficulties in administration. There is also evidence for reduced mortality using 200mg/kg Curosurf vs 100mg/kg Survanta. 

 

Ref :

 

Fox GF, Sothinathan O: The choice of surfactant for treatment of respiratory distress syndrome in preterm infants: A review of the evidence.  Infant 2005; 1:8-12

 

Halliday HL, Tarnow-Mordi WO, Corcoran JD, Paterson CC 1993: Multicentre randomised trial comparing high and low dose surfactant regimens for the treatment of respiratory distress

syndrome (Curosurf 4 trial).  Archives of Diseases in Childhood 69: 276-280

 

 

Sufficient information is not available on the effects of administering initial doses of CUROSURF other than 2.5 mL/kg (200 mg/kg), subsequent doses other than 1.25 mL/kg (100 mg/kg), administration of more than three total doses, dosing more frequently than every 12 hours, or initiating therapy with CUROSURF more than 15 hours after diagnosing RDS. Adequate data are not available on the use of CUROSURF in conjunction with experimental therapies of RDS, e.g., high-frequency ventilation.The FDA-approved initial dose of CUROSURF is 200 mg/kg (2.5 mL/kg). The 100 mg/kg (1.25 mL/kg) dose is approved for repeat dosing only.Clinical studies have not established that fewer doses, lower volume, or longer dosing intervals result in superior safety or efficacy based on clinically relevant end points.

 

 Ref :  Cogo PE, Facco M, Simonato M, et al. Pediatrics. 2009;124:e950-e957.

 

---------------

 

Regards

 

DR H SHARMA

London

UK

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  • 3 weeks later...

Are you using LISA procedure??

We still use the INSURE procedure ("intubation, surfactant, extubation")

(For those not familiar with "LISA" it means "Less invasive surfactant administration"

http://www.ncbi.nlm.nih.gov/pubmed/23446061

I am not certain but I guess that LISA is the same procedure as MIST, i.e. "Minimally-invasive surfactant therapy"

http://www.ncbi.nlm.nih.gov/pubmed/22684154 )

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Guest mmerocru

Yes, it is the same. But inicial dose of surfcactant in the reports is 100 mg/kg. We now are using 200 mg/kg ( first 100 and if tolered again 100 mg/kg)

We don't use sedation.

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  • 3 weeks later...

We use infasurf here 3ml/kg and instill half of the dose over 1-2 mins with one side of the baby up so the surfactant migrates to that side and then bag for 60 secs at slightly higher pressures then rotate the baby to the other side up and instil the other half..

If the baby is flat its hard to tell if the deposition of the surfactant if equal on both sides of the lungs.

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