surfactant use in older babies

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Hi, just wondering if anyone has evidence of surfactant being effective when used in older babies and children ie 12 month old?

thanks in advance

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Specializes in NICU, PICU, PCVICU and peds oncology.

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.

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Specializes in PICU/NICU.

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.

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Specializes in NICU, PICU, PCVICU and peds oncology.

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!

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Specializes in PICU/NICU.
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!!:nurse:

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Thanks for your replys,the kiddo in question was a 12month old with severe cor pulmonale and pulm hypertension,and we were really struggling to ventilate him,his sats stayed in the 60s on 100% o2,his lungs were so stiff,we thought mayb surfactant would help,it did for a while,but he just passed away,there is no sadder sound than a mothers silence or a father howl of disbelief

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Oh and dont worry about hijacking,ive never seen liquid ventilation,how did it work?

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Specializes in NICU, PICU, PCVICU and peds oncology.

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. :icon_hug:

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Specializes in PICU/NICU.

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

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Thanx,it was a rough weekend....the curosurf was more a desperate attempt at reducing the "stiffness" for want of a better word,of his lungs,PEEP was at 12 at one stage,we figured it couldnt hurt to try surf...the pulm hyp was being treated with sildenafil and nitric.but his outlook wasnt great from the start, :( im going to

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Oh and dont worry about hijacking,ive never seen liquid ventilation,how did it work?

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PLV (partial liquid ventilation) - essentially a pt's FRC was filled with perfluorocarbon, an inert chemical with a very high oxygen diffusivity and low surface tension. It's my understanding that the liquid had to be replaced periodically to reoxygenate. It also showed great promise for its ability to recriut atelectasized areas of the lung at very low pressures. I've never seen it, however I did write a paper on PLV in respiratory school. There have been some more recent studies of PLV in ARDS Pt's, however the mortality rate was higher than those ARDS Pt's studied in the initial ARDSnet studies with conventional ventilatory modes. I just googled PLV and came up with quite a bit.

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To the OP: Did you have a chance to use NO on your Pt?

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NO as in no or Nox?yes we tried the Nox it helped initially but not for long

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