Terapia de reemplazo con surfactante

Surfactant Replacement Therapy*
Timothy P. Stevens and Robert A. Sinkin Chest 2007;131;1577-1582 DOI 10.1378/chest.06-2371 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/131/5/1577.full.html

Chest is the official journal of the American College of Chest Physicians. It hasbeen published monthly since 1935. Copyright2007by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692

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Topics in Practice Management

Surfactant Replacement Therapy*
Timothy P. Stevens, MD, MPH; and Robert A. Sinkin, MD, MPH

Surfactant replacement therapy (SRT) has a proven role in the treatment of neonatal respiratory distress syndrome and severe meconium aspiration syndrome in infants, and may have a rolein the treatment of pediatric patients with ARDS. Although newer delivery mechanisms and strategies are being studied, the classic surfactant administration paradigm consists of endotracheal intubation, surfactant instillation into the lung, and stabilization with mechanical ventilation followed by extubation when stable on low respiratory support. Currently, this surfactant administrationprocedure is bundled into Current Procedural Terminology (CPT) codes used when providing intensive care. A specific CPT code for surfactant administration is scheduled to be introduced in 2007. This article reviews clinical issues in SRT and the practice management considerations necessary to provide this care. (CHEST 2007; 131:1577–1582)
Key words: neonatology; respiratory failure; surfactantAbbreviations: ALI acute lung injury; CDH congenital diaphragmatic hernia; CI confidence interval; CPAP continuous positive airway pressure; CPT Current Procedural Terminology; ECMO extracorporeal membrane oxygenation; FDA Food and Drug Administration; MAS meconium aspiration syndrome; RCT randomized controlled trial; RDS respiratory distress syndrome; RR relative risk; SP surfactant protein; SRTsurfactant replacement therapy

Kennedy, was born prematurely at 33 weeks gestation. Two days later, Patrick died of the most common complication of premature birth, respiratory distress syndrome (RDS). Occurring just 4 years after Avery and Mead1 first reported an association between RDS and surfactant deficiency, the death of Patrick Kennedy inspired aggressive research into the cause and treatment ofRDS and served as a catalyst in the development of regionalized neonatal
*From the Golisano Children’s Hospital at Strong (Dr. Stevens), University of Rochester, Rochester, NY; and the University of Virginia Children’s Hospital (Dr. Sinkin), Charlottesville, VA. Dr. Stevens is supported by National Institute of Child Health and Human Development K23 Award No. HD050646. The authors have reportedto the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Manuscript received September 26, 2006; revision accepted November 21, 2006. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal. org/misc/reprints.shtml).Correspondence to: Robert A. Sinkin, MD, MPH, University of Virginia Children’s Hospital, Division Chief, Neonatology, PO Box 800386, Charlottesville, VA 22908-0386; e-mail: ras9q@virginia.edu DOI: 10.1378/chest.06-2371
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