Minimally Invasive Surfactant Therapy

Post Dosing monitoring..

Why MIST?

- Remain in the bedside for minimum of 15 minutes post

administration.

- Re-evalutate and adjust FiO2 according to saturation goals every

5 min.; 30 minutes then 60 minutes post surfactant delivery.

- IMPORTANT: Patient should not be suction 2 hours following

surfactant administration unless absolutely necessary.

If patient must be suction before 30minute, provider may order

re-dosing.

MIST PROCEDURE

- Does not require prolong mechanical ventilation

- Does not require sedation

- Prevents Volutrauma and Barotrauma from

mechanical ventilation

- Attending or Fellow will lead the MIST administration

- RT needs to confirm that patient is stable on CPAP

- MD/Fellow prepare the Angiocath (BD angiocath 16GA 5.25in)

- Infant should be in a contained swaddle

- RN administer Buccal sucrose when needed

- Pre- Oxygenate pt. increased FiO2 10-20% from baseline before

procedure and keep sat >95%

- MD/Fellow use C-MAC to visually confirm proper placement

- RT should take a moment and insure that CPAP seal is good and

that head is midline with pt. breathing spontaneously

- RT attached surfactant syringe to the hub of angiocath then

administer surfactant in 3-4 bolus pushes, allowing enough time

between for pt. to spontaneously breathe and recover.

-When final bolus push was given RT will remove angiocath.

CUROSURF: Exogenous Surfactant

- Faster onset (per manufacturer: curosurf works within 5 minutes after administration.

- Less volume delivery (more surfactant delivery w/ less volume)

- Dosing: 2.5mL/kg initial dose can be repeated 2 times with 1.25mL/kg dosing that can be administer at approximately 12 hour intervals.

Minimally Invasive Surfactant Therapy

(MIST)

INDICATIONS FOR MIST

Questions ???

- Continious Non-Invasive Positive Pressure >8cmH20

- Higher FiO2 requirement >40%

- Signs of Respiratory Distress (Tachypnea & ↑ WOB

- A recent blood gas suggestive of Respiratory Acidosis

MIST VS INSURE

MIST:

- Does not require prolong mechanical ventilation

- Does not require sedation/anesthesia

- Prevents volutrauma and barotrauma from MV

INSURE

- 2 hrs or less MV

- Requires sedation/anethesia for intubation

- May cause volutrauma and barotrauma from MV

MIST (UCSF):

Minimally Invasive Surfactant Therapy

Insure:

Intubation Surfactant Rapid Extubation

Neonatal Respiratory Distress Syndrome (RDS)

RDS Affects approximately 40,000 infants each year in US and accounts for approximately 20% of neonatal deaths.

And is one of a major cause of morbidity and mortality in premature infants.

Causal: Primary cause of RDS is inadequate pulmonary surfactant. The structurally immature and surfactant-deficient lung has decreased compliance and a tendency to atelectasis.

RDS is greatly reduced with advancing gestational age, from 50% in infants born between 26-28weeks to 25% in those born at 30-32 weeks.

A. Pre surfactant administration

B. Post surfactant administration