Lung Surfactants Nursing Considerations

Lung surfactants are complex mixtures of lipids and proteins that reduce surface tension in the alveoli of the lungs. These vital substances are essential for normal breathing and are particularly crucial in treating respiratory distress syndrome (RDS) in premature infants.

Generic names: Beractant, Poractant alfa, Calfactant, Lucinactant

Brand names: Survanta, Curosurf, Infasurf, Surfaxin

Pharmacologic class: Pulmonary surfactant

Therapeutic class: Respiratory agent

Mechanism of action: Lung surfactants work by reducing surface tension at the air-liquid interface of the alveoli, preventing alveolar collapse during expiration and reducing the work of breathing. They also have immunomodulatory and anti-inflammatory properties.

Indications for use: Prevention and treatment of respiratory distress syndrome (RDS) in premature infants, acute respiratory distress syndrome (ARDS) in adults, meconium aspiration syndrome, and pneumonia.

Precautions and contraindications: Active pulmonary hemorrhage, congenital anatomic abnormalities of the lungs, and cardiovascular instability.

Drug Interactions

Concurrent use with inhaled nitric oxide requires careful monitoring
Diuretics may affect fluid balance and surfactant effectiveness
Corticosteroids may enhance surfactant production
Oxygen therapy needs careful titration when used with surfactants

Adverse Effects

Bradycardia during administration
Oxygen desaturation
Endotracheal tube obstruction
Pulmonary hemorrhage
Apnea
Hypertension or hypotension
Patent ductus arteriosus
Sepsis

Administration Considerations

Available preparations: Intratracheal suspension

Dosages: Varies by specific product and indication:

Beractant: 4 mL/kg birth weight divided into 4 quarter-doses
Poractant alfa: Initial 2.5 mL/kg birth weight, followed by 1.25 mL/kg if needed
Calfactant: 3 mL/kg birth weight
Lucinactant: 5.8 mL/kg birth weight

Administration timing and frequency depend on the specific product and patient response.

Nursing Considerations for Lung Surfactants

Related Nursing Diagnoses

Nursing Assessment

Assess respiratory status including:

Breathing rate and pattern
Breath sounds
Work of breathing
Oxygen saturation
Blood gas values

Evaluate cardiovascular status:

Heart rate
Blood pressure
Perfusion
ECG monitoring during administration

Monitor endotracheal tube position and patency
Assess temperature stability
Monitor for signs of pulmonary hemorrhage or infection

Nursing Interventions

Position infant correctly for administration:

Proper head position
Sequential position changes during dosing
Maintain proper ETT position

Monitor vital signs frequently during and after administration:

Continuous pulse oximetry
Frequent blood pressure measurements
Temperature monitoring
Respiratory rate and effort

Provide appropriate ventilator management:

Adjust settings as directed
Monitor for ETT obstruction
Suction only when necessary

Document response to therapy:

Oxygen requirements
Ventilator settings
Blood gas values
Clinical respiratory status

Maintain sterile technique during all procedures

Patient Teaching Associated with Lung Surfactants

Educate parents about:

Purpose of surfactant therapy
Expected outcomes
Potential complications
Recovery process

Explain monitoring procedures and equipment:

Meaning of alarms
Normal versus abnormal readings
When to notify staff

Provide emotional support and guidance:

Answer questions honestly
Include parents in care planning
Provide resources for support

Teach signs of respiratory distress to monitor:

Increased work of breathing
Color changes
Agitation or lethargy

Explain follow-up care requirements:

Ongoing monitoring needs
The potential need for repeat doses
Long-term respiratory care

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.

References and Sources

Sweet, D. G., Carnielli, V., Greisen, G., Hallman, M., & Ozek, E. (2023). European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2023 Update. Neonatology, 114(4), 342-368.
Ardell, S., Pfister, R. H., & Soll, R. (2022). Animal derived surfactant extract versus protein free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Cochrane Database of Systematic Reviews, (8).
Polin, R. A., Carlo, W. A., Committee on Fetus and Newborn, & American Academy of Pediatrics. (2023). Surfactant Replacement Therapy for Preterm and Term Neonates With Respiratory Distress. Pediatrics, 151(2), e2022060714.
De Luca, D., van Kaam, A. H., Tingay, D. G., Courtney, S. E., Danhaive, O., Carnielli, V. P., & Zimmermann, L. J. (2021). The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity. The Lancet Respiratory Medicine, 9(4), 359-372.