The impact of surfactant replacement therapy on cerebral and systemic circulation and lung function

Abstract

In RDS patients there is a significant drop of MAP, HR, MCBFV and FiO2 after bolus surfactant administration.

Cerebral Blood Flow Velocity Changes After Bovine Natural Surfactant Instillation

“…Most of these studies demonstrated significant changes in blood pressure and CBFV within 5 minutes after surfactant administration and then returned to baseline levels within 20 to 30 minutes. [7][8][9][10][11] In human newborn infants, there are only two studies 12,13 using synthetic surfactant (colfoceril palmitate) (Exosurf; Glaxo Wellcome, Research Triange Park, NC), and these studies showed conflicting results with regard to CBFV changes. There is only one study using bovine natural surfactant that showed no significant changes in CBFV with surfactant administration.…”

“…Both variables were included because they have been reported to have an effect on CBFV and blood pressure. 4 -6 Furthermore, an increase in PACO 2 has been reported with surfactant administration in various studies, [7][8][9][10][11][12][13] and associated changes in CBFV were explained by PACO 2 changes. 12 The software used for statistical analysis was the S-Plus statistics package (Mathsoft, Seattle, WA).…”

“…6 In an attempt to relate cerebral blood flow changes to surfactant administration, the influence of surfactant on cerebral blood flow velocity (CBFV) was studied by several investigators but with conflicting results. [7][8][9][10][11][12][13][14] Most studies involved a small number of patients and used different preparations of surfactant and different techniques of administration.…”

Partial Liquid Ventilation in the Extremely Preterm Infant: Potential Benefits and Harms

“…Many respiratory problems or treatments are known to alter cerebral blood flow and/or increase the risk of intraventricular haemorrhage. These include:  intratracheal surfactant instillation (has been shown to increase or decrease cerebral blood flow velocity on Doppler ultrasound (Schipper, 1997;Saliba, 1994;Kaiser, 2004);  asynchronous breathing mechanical ventilation (increases the variability of cerebral blood flow (Rennie, 1987);  endotracheal tube suction (has been shown to increase or decrease cerebral blood flow on near infrared spectroscopy (Limperopoulos, 2008;Kohlhauser, 2000);  endotracheal tube retaping increases cerebral blood flow on near infrared spectroscopy (Limperopoulos, 2008);  pneumothorax increases cerebral blood flow velocity on Doppler ultrasound, and increases the incidence of intraventricular haemorrhage. Mehrabani, 1991) The alterations in cerebral blood flow during the administration surfactant are of particular concern because surfactant administration is comparable to the intratracheal administration of perfluorocarbon when starting partial liquid ventilation.…”

Lung Diseases - Selected State of the Art Reviews

“…Many respiratory problems or treatments are known to alter cerebral blood flow and/or increase the risk of intraventricular haemorrhage. These include:  intratracheal surfactant instillation (has been shown to increase or decrease cerebral blood flow velocity on Doppler ultrasound (Schipper, 1997;Kaiser, 2004);  asynchronous breathing mechanical ventilation (increases the variability of cerebral blood flow (Rennie, 1987);  endotracheal tube suction (has been shown to increase or decrease cerebral blood flow on near infrared spectroscopy (Limperopoulos, 2008;Kohlhauser, 2000);  endotracheal tube retaping increases cerebral blood flow on near infrared spectroscopy (Limperopoulos, 2008);  pneumothorax increases cerebral blood flow velocity on Doppler ultrasound, and increases the incidence of intraventricular haemorrhage. Mehrabani, 1991) The alterations in cerebral blood flow during the administration surfactant are of particular concern because surfactant administration is comparable to the intratracheal administration of perfluorocarbon when starting partial liquid ventilation.…”