November 27, 201212 yr hi this is very important topic .we have just 2to4 ventilators in our city in two different private hospitals .as most pediatricans work in public hospt and there arent any vents we dont attempt intubation because post intubation bagging cant be continued manualy for long,therefore intubation has now almost become out of practice. ido understand that spontaneous breathing can occur followed by extubation.my queston is that under these circumstances what is the role of nebulised surfactant and how is it used exactly in prematures followed by some fom of manual cpap.thanks
December 3, 201212 yr Author Nebulized surfactant is still experimental so as of today the only recommended route of administering surfactant is endotracheally. May be in a few years time we will have nebulized surfactant. IF there are no ventilators you can use INSURE and even if surfactant is not available just use plain CPAP and you will be able to save many preterm newborns
April 25, 201311 yr can u give me link or paper how can i give surfactant ,because i want to know ideal practise thanks
April 25, 201311 yr can u give me link or paper how can i give surfactant ,because i want to know ideal practise thanks There are several papers describing the method, for example: http://www.ncbi.nlm.nih.gov/pubmed/20971722 http://www.ncbi.nlm.nih.gov/pubmed/20180736 http://www.ncbi.nlm.nih.gov/pubmed/17476269 http://www.ncbi.nlm.nih.gov/pubmed/19117872 I personally think MIST and INSURE are really two versions of the same idea/practise, the major difference being the degree of sedation during the procedure. Our protocol includes 1. premedication with atropine, fentanyl, penthotal and celocurin 2. intubation and administration of surfactant 3. await spontaneous breathing again and when it comes back (within minutes usually) extubation and back to cpap.
May 3, 201311 yr In the German speaking countries the technique described in these articles has found widspread use: fn.bmj.com/content/early/2011/.../adc.2010.209098 www.thelancet.com/.../PIIS0140-6736(11)60986-0 www.ncbi.nlm.nih.gov/pubmed/17359406
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