Respiratory Stimulants and Pulmonary Surfactants
Respiratory stimulants (analeptic drugs) have a limited place in the treatment of ventilatory failure in patients with chronic obstructive pulmonary disease. They are effective only when given by intravenous injection or infusion and have a short duration of action. Their use has largely been replaced by ventilatory support including nasal intermittent positive pressure ventilation. However, occasionally when ventilatory support is contra-indicated and in patients with hypercapnic respiratory failure who are becoming drowsy or comatose, respiratory stimulants in the short term may arouse patients sufficiently to cooperate and clear their secretions. Respiratory stimulants can also be harmful in respiratory failure since they stimulate non-respiratory as well as respiratory muscles. They should only be given under expert supervision in hospital and must be combined with active physiotherapy.
Indications: Post-Anesthesia Respiratory Depression, Respiratory Depression, Neonatal Apnea
Contraindications: Acute Asthma Attack, Acutely Decompensated Chronic Heart Failure, Cerebral Edema, Cerebrovascular Accident, Epilepsy, Flail Chest, Head Injury, Neuromuscular Blockade, Paralysis, Pheochromocytoma, Physical Obstruction of Respiratory Tract, Pneumothorax, Pulmonary Fibrosis, Pulmonary
Thromboembolism, Severe Coronary Artery Disease, Severe Uncontrolled Hypertension
Dose and Administration: Postoperative respiratory depression, by intravenous injection over at least 30 seconds, 1–1.5 mg/kg repeated if necessary after intervals of 1 hour or alternatively by intravenous infusion, 2–3 mg/minute adjusted according to response; child not recommended. Acute respiratory failure, by intravenous infusion, 1.5–4 mg/minute adjusted according to response (given concurrently with oxygen and whenever possible monitor with frequent measurement of blood gas tensions); child not recommended.
Pulmonary surfactants are used in the management of respiratory distress syndrome (hyaline membrane disease) in neonates and preterm neonates. They may also be given prophylactically to those considered at risk of developing the syndrome. Continuous monitoring is required to avoid hyperoxaemia caused by rapid improvement in arterial oxygen concentration. Pulmonary haemorrhage has been rarely associated with therapy especially in more preterm neonates; obstruction of the endotracheal tube by mucous secretions has also been reported.
Indications: treatment of respiratory distress syndrome in preterm neonates over 700 g; prophylaxis of respiratory distress syndrome in preterm neonates less than 32 weeks post-menstrual age.
Contraindications: NO DATA AVAILABLE
Dose and Administration: By endotracheal tube, phospholipid 100 mg/kg equivalent to a volume of 4 mL/kg, preferably within 8 hours of birth; may be repeated within 48 hours at intervals of at least 6 hours for up to 4 doses.