Pulmonary surfactant is used as a

medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

to treat and prevent

respiratory distress syndrome Infant respiratory distress syndrome (IRDS), also known as surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD), is a syndrome in premature infants caused by developmental insufficiency of pulmonary surfacta ...

in newborn babies. Prevention is generally done in babies born at a

gestational age In obstetrics, gestational age is a measure of the age of a pregnancy taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method, if available. Such metho ...

of less than 32 weeks. It is given by the

endotracheal tube A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes are a ...

. Onset of effects is rapid. A number of doses may be needed. Side effects may include

slow heart rate Bradycardia, also called bradyarrhythmia, is a resting heart rate under 60 beats per minute (BPM). While bradycardia can result from various pathological processes, it is commonly a physiological response to cardiovascular conditioning or due t ...

and low oxygen levels. Its use is also linked with

intracranial bleeding Intracranial hemorrhage (ICH) refers to any form of bleeding within the skull. It can result from trauma, vascular abnormalities, hypertension, or other medical conditions. ICH is broadly categorized into several subtypes based on the location ...

. Pulmonary surfactant may be isolated from the lungs of cows or pigs or made artificially.

Pulmonary surfactant Pulmonary surfactant is a surface-active complex of phospholipids and proteins formed by Type II cells, type II alveolar cells. The proteins and lipids that make up the surfactant have both hydrophilic and hydrophobic regions. By adsorption, adso ...

was discovered in the 1950s and a manufactured version was approved for medical use in the United States in 1990. It is on the

World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health s ...

Medical uses

Pulmonary surfactant is used to treat and prevent

in newborn babies. Prevention is generally done in babies born less than 32 weeks

. Tentative evidence supports use in

drowning Drowning is a type of Asphyxia, suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incidents. Most instances of fatal drowning occur alone or in situations where othe ...

. Surfactant administration can also be effective in

meconium aspiration syndrome Meconium aspiration syndrome (MAS), also known as neonatal aspiration of meconium, is a medical condition affecting newborn infants. It describes the spectrum of disorders and pathophysiology of newborns born in meconium-stained amniotic fluid (MS ...

where it has been shown to help lower length of stay.

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. Ex-situ measurements of

surface tension Surface tension is the tendency of liquid surfaces at rest to shrink into the minimum surface area possible. Surface tension (physics), tension is what allows objects with a higher density than water such as razor blades and insects (e.g. Ge ...

and

interfacial rheology Interfacial rheology is a branch of rheology that studies the flow of matter at the interface between a gas and a liquid or at the interface between two immiscible liquids. The measurement is done while having surfactants, nanoparticles or other su ...

can help to understand the functionality of pulmonary surfactants. Synthetic pulmonary surfactants: *

Colfosceril palmitate Colfosceril palmitate (trade name Exosurf) is a drug used as a pulmonary surfactant. It is a drug that is used in surfactant deficient conditions such as infant respiratory distress syndrome in newborns. See also *Dipalmitoylphosphatidylcholine ...

(Exosurf) – a mixture of DPPC with hexadecanol and tyloxapol added as spreading agents *

Pumactant Pulmonary surfactant is used as a medication to treat and prevent Infant respiratory distress syndrome, respiratory distress syndrome in newborn babies. Prevention is generally done in babies born at a Gestational age (obstetrics), gestationa ...

(Artificial Lung Expanding Compound or ALEC) – a mixture of DPPC and PG *

Lucinactant Lucinactant (trade name Surfaxin) is a liquid medication used to treat infant respiratory distress syndrome. It is a pulmonary surfactant for infants who lack enough natural surfactant in their lungs. Whereas earlier medicines of the class, such a ...

(KL4, trade name Surfaxin) – composed of DPPC, palmitoyl-oleoyl phosphatidylglycerol, and palmitic acid, combined with a 21 amino acid synthetic peptide ( sinapultide) that mimics the C-terminal helical domain of SP-B. * Ventricute - DPPC, rSP-C Animal-derived surfactants: *

Beractant Beractant, also known by the trade name of Survanta, is a modified bovine pulmonary surfactant containing bovine lung extract (phospholipids, neutral lipids, fatty acids, and bovine surfactant proteins), to which synthetic DPPC, tripalmitin and ...

(Survanta) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by

Abbvie AbbVie Inc. is an American pharmaceutical company headquartered in North Chicago, Illinois. It is ranked sixth on the list of largest biomedical companies by revenue. In 2023, the company's seat in Forbes Global 2000 was 74, and rank 89 on the ...

** (Beraksurf) – extracted from minced cow lung with additional DPPC, palmitic acid and tripalmitin, manufactured by Tekzima *

Calfactant Calfactant, also known as Infasurf, is an intratracheal suspension derived from the natural surfactant in calf lungs. It is used in premature infants with lung surfactant deficiency that causes infant respiratory distress syndrome Infant re ...

(Infasurf) – extracted from calf lung lavage fluid, manufactured by ONY Biotech. *

Poractant alfa Poractant alfa is a pulmonary surfactant sold under the brand name Curosurf by Chiesi Farmaceutici. Poractant alfa is an extract of natural porcine lung surfactant. As with other surfactants, marked improvement on oxygenation may occur within mi ...

(Curosurf) – extracted from material derived from minced pig lung * Surfactant TA (Surfacten) – derived from cows, manufactured by Tokyo Tanabe Co. * Bovactant SF-RI (Alveofact) – extracted from cow lung lavage fluid, manufactured by

Boehringer Ingelheim C.H. Boehringer Sohn AG & Co. is the parent company of the Boehringer Ingelheim group, which was founded in 1885 by Albert Boehringer (1861–1939) in Ingelheim am Rhein, Germany. As of 2018, Boehringer Ingelheim is one of the world's List of la ...

History

Researcher John Clements identified surfactants and their role in the 1950s.

Mary Ellen Avery Mary Ellen Avery (May 6, 1927 – December 4, 2011), also known as Mel, was an American pediatrician. In the 1950s, Avery's pioneering research efforts helped lead to the discovery of the main cause of respiratory distress syndrome (RDS) in premat ...

soon after showed that the lungs of premature infants could not produce surfactants. Exosurf, Curosurf, Infasurf, and Survanta were the initial surfactants approved for use in the US. In 2012, the US

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...

approved an additional synthetic surfactant,

lucinactant Lucinactant (trade name Surfaxin) is a liquid medication used to treat infant respiratory distress syndrome. It is a pulmonary surfactant for infants who lack enough natural surfactant in their lungs. Whereas earlier medicines of the class, such a ...

(Surfaxin).

Research

Surfactant may be beneficial in those with COVID-19 associated

acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin co ...

References

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