surfactant use in older babies

I've seen it used in a handful of children post-aspiration/near-drowning and one or two severe respiratory failure. Results are mixed, but there is a role for it in certain instances.

Like Jan, Ive only seen it a few times in older ones... mostly aspirations- not quite to ECMO yet. I'm not sure what that literature says about it, but I've seen it work.

Does anyone remember liquid ventilation? It came and went pretty quickly- it think it was kinda on the same thought process.

I've read about it but never seen it. The article was from about 15 years ago. The idea of putting anything called perfluorocarbon into somebody's lungs seems so wrong!

We used it a couple of times- I was still quite green so I was never assigned a liquid vent pt. But my preceptor showed me a kiddo on it one day. The secretions kinda just float to the top of the ETT and when you suction them out, you measure how much "liquid" came out and then add liquid back. YUCK! Musta not been to benificial... I've not seen it again since the trials.

Sorry to hijack OP!!

qcumba, you're quite right, there is nothing more heart-wrenching.

One of our intensivists is a world-class specialist in pulmonary hypertension. He can be quite creative in treating the kids, if he thinks there's a chance for survival. But he's also very good at bringing things to their natural conclusion in the most compassionate way possible when there is no getting better. I quite admire that trait in him. So far I haven't seen him suggest surfactant in that situation, and I really don't think it would work, because the intrinsic problem isn't the lungs, it's the vessels and eventually the right ventricle. Carvedilol, bosentan, sildenafil and epoprostenol would be his choices, I feel sure... since we have a similar scenario on our unit right now. We just found out that our baby has a whopping secundum ASD though so there's lots of potential for improvement for him.

I feel your loss, qcumba.

qcumba- sorry to hear about your patient. Sounds like a bad day. (((hugs))) to you!