Lung Surfactants: Generic and Brand Names
- Lung surfactants
- beractant (Survanta)
- calfactant (Infasurf)
- poractant (Curosurf)
Disease Spotlight: Respiratory Distress Syndrome
Respiratory distress syndrome (RDS) causes obstruction at the alveolar level. It shows up in premature infants delivered before their lungs are fully developed, while surfactant levels are still very low. Surfactant lowers surface tension in the alveoli so they stay open and let gases flow. When levels are low, the alveoli do not expand or take in air, gas exchange drops, oxygen falls, and the whole body goes into distress as cells starve for oxygen. Treatment instills surfactant to prevent atelectasis and let the lungs expand.
Acute respiratory distress syndrome (ARDS) is a different problem: progressive loss of lung compliance and worsening hypoxia. It follows a severe insult such as cardiovascular collapse, major burns, severe trauma, or rapid depressurization. Treatment reverses the underlying cause and adds ventilation support.
What are Lung Surfactants?
Lung surfactants are naturally occurring lipoproteins containing lipids and apoproteins that reduce surface tension within the alveoli, letting them expand for gas exchange.
Therapeutic Actions
Lung surfactants replace the surfactant missing in the lungs of neonates with RDS.
Indications
Rescue treatment of infants who have RDS. Prophylactic treatment of infants at high risk for RDS (birth weight <1,350 g, or birth weight >1,350 g with evidence of respiratory immaturity). Surfactant replacement is the mainstay intervention for neonatal RDS and significantly reduces mortality along with the risk of pneumothorax, pulmonary air leak, and intraventricular hemorrhage (StatPearls). The drug is also being tried in adult RDS and in adults after near drowning.
Pharmacokinetics
These drugs are instilled directly into the trachea and act immediately on instillation.
Contraindications and Cautions
Because lung surfactants are emergency drugs in the newborn, there are no contraindications.
Adverse Effects
- Cardiovascular: Patent ductus arteriosus, bradycardia, intraventricular hemorrhage, hypotension.
- Respiratory: Pneumothorax, pulmonary air leak, pulmonary hemorrhage, apnea.
- Systemic: Sepsis, infection.
Nursing Considerations for Lung Surfactants
Nursing Assessment
Screen for the time of birth and exact weight to set the right dose; because this is an emergency drug, there are no contraindications to screen for. Do a physical exam to set baseline data for judging effectiveness and catching adverse effects. Assess skin temperature and color to evaluate perfusion. Monitor respirations, adventitious sounds, endotracheal tube placement and patency, and chest movements to judge the drug and its delivery. Check blood pressure, pulse, and arterial pressure to track the infant's status. Check blood gases and oxygen saturation to monitor effectiveness. Check temperature and CBC to monitor for sepsis.
Nursing Diagnosis and Care Planning
Decreased cardiac output related to cardiovascular and respiratory effects of the drug. Risk for injury related to prematurity and risk of infection. Ineffective airway clearance related to possible mucus plugs. Deficient knowledge regarding drug therapy (for parents).
Nursing Implementation with Rationale
Monitor the patient continuously during administration and until stable, ready to provide life support. Confirm endotracheal tube placement with bilateral chest movement and lung sounds so the drug reaches both lungs. Have staff view the manufacturer's teaching video before regular use to cover the technical aspects of administration. Suction the infant immediately after administration, but do not suction for 2 hours afterward unless clinically necessary, to let the drug work. Support and encourage the parents, explaining the drug's use so they can cope with the diagnosis and treatment. Continue other supportive measures for the infant's immaturity, since this is only one part of the care a premature infant needs.
Evaluation
Monitor the response to the drug (improved breathing, alveolar expansion). Watch for adverse effects (pneumothorax, patent ductus arteriosus, bradycardia, sepsis). Evaluate the teaching plan and support parents as appropriate. Track the effectiveness of other measures to support and stabilize the patient, including those tied to the infant's immaturity.
Frequently Asked Questions
What do lung surfactants do? They replace the natural surfactant a premature lung cannot yet make. Surfactant lowers surface tension in the alveoli so they stay open for gas exchange; without it the alveoli collapse, oxygen falls, and the infant goes into distress (StatPearls).
How are lung surfactants given? They are instilled directly into the trachea through the endotracheal tube and act on contact. Confirm tube placement with bilateral chest movement and lung sounds first so the drug reaches both lungs.
Why do you avoid suctioning for 2 hours after a dose? Suctioning would pull the freshly instilled drug back out before it can spread and coat the alveoli. Hold routine suctioning for about 2 hours unless it is clinically necessary.
Which infants get lung surfactant? Infants with RDS get rescue treatment, and infants at high risk (birth weight under 1,350 g, or over 1,350 g with evidence of respiratory immaturity) may get prophylactic treatment. Surfactant replacement is the mainstay of RDS care and lowers mortality and air-leak complications (StatPearls).
Are there contraindications to lung surfactant in a newborn? No. Because it is an emergency drug for a surfactant-deficient newborn, there are no contraindications; the priority is screening time of birth and exact weight to set the dose.
What are the main adverse effects to watch for? Bradycardia and oxygen desaturation during instillation, plus pneumothorax, pulmonary hemorrhage, patent ductus arteriosus, and signs of sepsis. Monitor the infant continuously during and after the dose, ready to provide full life support.