Pulmonary surfactant (medication) explained

Drug Name:Pulmonary surfactant
Synonyms:Beractant, Poractant alfa, others
Pronounce:Curosurf, Survanta, others
Dailymedid:Poractant_alfa
Cas Number:129069-19-8
Unii:KE3U2023NP
Atc Prefix:R07
Atc Suffix:AA
Chemspiderid:none

Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies.[1]

Prevention is generally done in babies born at a gestational age of less than 32 weeks.[1] It is given by the endotracheal tube.[1] Onset of effects is rapid. A number of doses may be needed.[2]

Side effects may include slow heart rate and low oxygen levels.[1] Its use is also linked with intracranial bleeding.[1] Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially.[1] [3]

Pulmonary surfactant was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990.[4] It is on the World Health Organization's List of Essential Medicines.[5]

Medical uses

Pulmonary surfactant is used to treat and prevent respiratory distress syndrome in newborn babies.[1] Prevention is generally done in babies born less than 32 weeks gestational age.[1] Tentative evidence supports use in drowning.[6]

Surfactant administration can also be effective in meconium aspiration syndrome where it has been shown to help lower length of stay.[7] [8]

For patients with acute respiratory distress syndrome (ARDS), surfactant has not been shown to reduce mortality. However, it may be beneficial in those with COVID-19 associated ARDS.[9] [10]

Types

There are a number of types of pulmonary surfactants available. Like their natural counterparts, pulmonary surfactant preparations consist of phospholipids (mainly DPPC) combined with spreading agents such as SP-B and SP-C.[11] Ex-situ measurements of surface tension and interfacial rheology can help to understand the functionality of pulmonary surfactants.[12]

Synthetic pulmonary surfactants:

Animal-derived surfactants:

History

Researcher John Clements identified surfactants and their role in the 1950s. Mary Ellen Avery soon after showed that the lungs of premature infants could not produce surfactants.[15]

Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants FDA approved for use in the U.S.[16]

In 2012, the US FDA approved an additional synthetic surfactant, lucinactant (Surfaxin).[17]

External links

Notes and References

  1. Book: British National Formulary: BNF 69. 2015. British Medical Association. 9780857111562. 217. 69.
  2. Book: Martin RJ, Crowley MA . Respiratory Problems . Fanaroff AA, Fanaroff JM . Klaus and Fanaroff's Care of the High-Risk Neonate, Expert Consult - Online and Print,6: Klaus and Fanaroff's Care of the High-Risk Neonate. 2013. Elsevier Health Sciences. 978-1416040019. 252. https://books.google.com/books?id=cWXTcL82Q6IC&pg=PA252. en. live. https://web.archive.org/web/20170109021357/https://books.google.ca/books?id=cWXTcL82Q6IC&pg=PA252. 2017-01-09.
  3. Book: Wratney AT, Cheifetz IM . Gases and Drugs Used in Support of the Respiratory System . Slonim AD, Pollack MM . Pediatric Critical Care Medicine. 2006. Lippincott Williams & Wilkins. 9780781794695. 724–725. https://books.google.com/books?id=_XavFllbnS0C&pg=PA725. en. live. https://web.archive.org/web/20170109021124/https://books.google.ca/books?id=_XavFllbnS0C&pg=PA725. 2017-01-09.
  4. Book: Lantos JD, Meadow WL . The Era of Exposed Ignorance, 1982-1992 . Neonatal Bioethics: The Moral Challenges of Medical Innovation. 2006. JHU Press. 9780801883446. 54–56. https://books.google.com/books?id=5BuWwVAxuZkC&pg=PA56. en. live. https://web.archive.org/web/20170109022320/https://books.google.ca/books?id=5BuWwVAxuZkC&pg=PA56. 2017-01-09.
  5. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO .
  6. Book: Ferguson JD, De Guzman J . Cardiac Arrest in Special Populations . Brady B, Charlton NP, Lawner BJ, Sutherland SF . Cardiac Arrest, An Issue of Emergency Medicine Clinics. 2012. Elsevier Health Sciences. 978-1455742769. 175. https://books.google.com/books?id=NMHztDbemToC&pg=PA175. en. live. https://web.archive.org/web/20170109022316/https://books.google.ca/books?id=NMHztDbemToC&pg=PA175. 2017-01-09.
  7. El Shahed AI, Dargaville PA, Ohlsson A, Soll R . Surfactant for meconium aspiration syndrome in term and late preterm infants . The Cochrane Database of Systematic Reviews . 2014 . 12 . CD002054 . December 2014 . 25504256 . 7027383 . 10.1002/14651858.CD002054.pub3 .
  8. Book: Walsh B . Neonatal and Pediatric Respiratory Care . Elsevier . 2019 . 244–261 . 978-0-323-47947-9 .
  9. Davidson WJ, Dorscheid D, Spragg R, Schulzer M, Mak E, Ayas NT . Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis . Critical Care . 10 . 2 . R41 . 2006 . 16542488 . 1550886 . 10.1186/cc4851 . free .
  10. Heching M, Lev S, Shitenberg D, Dicker D, Kramer MR . Surfactant for the Treatment of ARDS in a Patient With COVID-19 . English . Chest . 160 . 1 . e9–e12 . July 2021 . 33493441 . 7825915 . 10.1016/j.chest.2021.01.028 .
  11. Nkadi PO, Merritt TA, Pillers DA . An overview of pulmonary surfactant in the neonate: genetics, metabolism, and the role of surfactant in health and disease . Molecular Genetics and Metabolism . 97 . 2 . 95–101 . June 2009 . 19299177 . 2880575 . 10.1016/j.ymgme.2009.01.015 .
  12. Bertsch P, Bergfreund J, Windhab EJ, Fischer P . Physiological fluid interfaces: Functional microenvironments, drug delivery targets, and first line of defense . Acta Biomaterialia . 130 . 32–53 . August 2021 . 34077806 . 10.1016/j.actbio.2021.05.051 . 235323337 . free . 20.500.11850/498803 . free .
  13. Web site: KL4 Surfactant Technology . Windtree Therapeutics, Inc.. 29 November 2017. https://web.archive.org/web/20180729130739/http://www.windtreetx.com/kl4-surfactant-technology2/. July 29, 2018. dead.
  14. Web site: European Patent Office. T 0723/94 (Surfactant composition/TOKYO TANABE CO) of 18.2.1999 . 2022-04-30 . en.
  15. News: Palca J . 3 August 2015. How A Scientist's Slick Discovery Helped Save Preemies' Lives. NPR. 3 August 2015. live. https://web.archive.org/web/20150803140737/http://www.npr.org/sections/health-shots/2015/08/03/422620170/how-a-scientists-slick-discovery-helped-save-preemies-lives. 3 August 2015.
  16. Improving pulmonary surfactants . Taeusch HW, Lu K, Ramierez-Schrempp D . 2002 . Acta Pharmacologica Sinica . 23 Suppl . 11–5 . live . https://web.archive.org/web/20150301131212/http://www.chinaphar.com/1671-4083/23/11s.pdf . 2015-03-01 .
  17. Web site: Surfaxin (lucinactant) Intratracheal Suspension . Drug Approval Package . U.S. Food and Drug Administration . 2022-04-30 .

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