the force that holds the liquid surface intact at the liquid-gas interface. Measured in dynes/centimeter (dyn/cm)
Explains the relationship between the internal pressure, surface tension, and the radius of a bubble.
P = (2 x ST) / r
Type II Alveolar Cells
Where surfactant is produced, stored, and released.
Regulates surface tension in the alveoli
Replaces missing pulmonary surfactant in respiratory distress syndrom (RDS) of newborn. Replaces the deficient endogenous surfactant pool.
Dose: 4 ml/kg given in quarters
Administered through 5 french catheter placed into ETT
Dose: 3 ml/kg delivered in 2 doses
Administration: Side port or catheter
Dose: 2.5 ml/kg in 2 doses
aka: Exosurf Neonatal
Dose: 5 ml/kg in 2 half doses
Administration: Side port
Methods for Delivering surfactant in Infants
1. Instillation through side-port adaptor
2. Instillation through catheter
Complication of Surfactant Therapy
1. AW occlusion
4. High PaO2
5. Over ventilation
7. Pulmonary hemorrhage
Endogenous hormones produced in the adrenal cortex, which regulates basic metabolic functions in the body, as well as exerts an anti-inflammatory effect.
Regulate basic metabolic function in the body. Outer zone which produces Glucocorticoids, Mineralocorticoids, Androgens.
Inner zone which produces epinephrine, Norepinephrine, and dopamine. Reacts to stress and releases Catecholamines
Hypothalamus-Pituitary Adrenal Axis (HPA)
Stimulation of hypothalamus causes impulses to be sent to an area called the Median Eminence
Median Eminence (HPA)
Releases Corticotropin Releasing Factor
Corticotropin Releasing Factor (CRF)
Circulates through the portal vessel to the Anterior Pituitary (Adenohypophysis)
Anterior Pituitary (HPA)
Releases adrenocorticotropic Hormone (ACTH) into the bloodstream
Adrenocorticotropic Hormone (ACTH)
Stimulates the Adrenal Cortex to secrete Glucocorticoids such as Cortisol
Regulate metabolism of carbs, fats, and proteins to increase glucose levels for body energy. Then will produce body energy and relieve stress by inhibiting the hypothalamuc thus completeing the axis.
Pathway for release and control of steroids.
Stimulation of hypothalamus sends impulses to median eminence relseases corticotropin releasing factor (CRF) to anterior pituitary gland which releases adenocorticotropic hormone (ACTH) into blood which stimulates adrenal cortex to release Glucocorticoids.
24 hour cucle where corticosteroids and ACTH levels increase and decrease.
Enhances lipocortin which inhibits phospholipase A2 thereby preventing the archidonic acid cascade.
Suppresses other cells (mast, esoinophils, T-lymphocytes, and macrophages) involved in the inflammatory response.
Increases anti-inflammatory proteins and receptors and suppresses pro inflammatory proteins.
Involves redness, swelling, pain, and heat at site as results of:
1. increased vasular permeability
2. Leukocyte infiltration
4. mediator release
2. inhalation of noxious substances
4. allergic responses
Common Inflammatory Lung diseases
Asthma and Chronic Bronchitis
Hydrocortisone (Cortisol, Cortisone)
Used for short term treatment of inflammatory process.
Prednisone and Decadron
Oral agents given to wean off IV steroids or to contunie steroids treatment at home
Must be tapered off
May be given for stridor post extubation
Beclomethasone Dipropionate (Vanceril)
Triamcinolone Acetonide (Azmacort)
Fluticasone Propionate (Flovent. Flonase)
Budesonide (Pulmicort, Rhinocort)
Fluticasone Propionate and Salmeterol (advair)
Budesonide and Formoterol (symbicort)
Vanceril, beclovent, QVAR
Uses a MDI - long acting (12 hrs)
Dose: 2 puffs every Q12
Water insoluble = less systemic absorption
Require 12-14 inhalations.day
Build in space
Longer duration than azmacort
MDI in 3 strengths: 44, 110, 220
Once a day or BID
Combinded with Serevent, advair
Only 10% enters systems
Dose - .5 ml Q12 or daily
Combined with Foradil as Symbicort
Fluticasone Propionate/ Salmeterol
Serevent 50 ug.
1-2 puffs DPI once or twice daily
Anabolic (Androgenic) Steroids
Promotes muscle development
Treats natural androgen Deficiency
Promotes secondary male characteristics
Often abused by athletes
Stimulates RBC's in certain types of anemia