Survanta® [Beractant]

Only for endotracheal administration.
Drug survant^® should be used by a doctor with experience in intubation, mechanical ventilation and care for premature infants, or under his supervision.
A significant improvement in oxygenation can be achieved within a few minutes after administration of the drug, to prevent hyperoxia, careful medical monitoring and monitoring of systemic oxygenation is necessary.
The dose of the drug is calculated as 100 mg of the drug per 1 kg of body weight, based on the weight at the time of birth. Table 1 shows the total dose of the drug, depending on the weight of the child at birth.
Table 1. Doses of Survant^®

During the first 48 hours of a child's life, 4 doses of Beractant may be administered. The drug should be administered no more than once every 6 hours.

Directions for use
Before using the drug Survant^® the vial should be inspected to prevent discoloration of the drug.
If a precipitate has formed during storage, gently rotate the vial (DO NOT SHAKE!) To dissolve it. In this case, a small amount of foam may form on the surface; this is a natural property of Survant.^® . 
Before the introduction of the drug Survant^® warm it at room temperature for at least 20 minutes or in hands for at least 8 minutes. FOR WARMING PREPARATION OF THE SURVANT^® DO NOT USE OTHER METHODS.
Closed, unused vial of the drug Survant^®which has been warmed to room temperature, can be re-placed in a refrigerator for 24 hours, cooled and stored for later use. Drug survant^® do not warm and re-cool more than once. Each bottle of drug Survant^® designed for single use. Used vial with the remnants of the drug should not be applied. PREPARATION OF SURVANT^® DOES NOT REQUIRE BREEDING OR ULTRASOUND BEFORE USE.
Drug administration
general information
Drug survant^® is introduced endotracheally by means of installations through the French probe No. 5 with a hole at the end in one of the following ways:

• insertion of the probe into the baby’s endotracheal tube, disconnecting it from the ventilator for a short time;
• insertion of the probe through the suction valve without disconnecting the endotracheal tube from the ventilator;
• installation through the second lumen of the double-lumen endotracheal tube.

If the drug is installed through a probe with a hole at the end, the probe length should be reduced so that the end of the probe is a short distance from the endotracheal tube above the bifurcation of the trachea of ​​the child. The introduction of the drug in the main bronchi is unacceptable.
In order for the drug Survant^® evenly distributed over the lungs, each dose is divided into equal fractional doses. Each dose can be divided into 2 or 4 equal parts. Each fractional dose is administered at different positions of the child.
When dividing the dose of the drug Survant^® 2 equal parts are recommended to enter it in the following positions

• Head and torso rotated approximately 45 ° to the right.
• Head and torso rotated about 45 ° to the left. When dividing the dose of the drug Survant^® PA 4 parts, it is recommended to enter it in the following positions

1. Head and torso tilted 5-10 ° down; head turned to the right.

2. The head and torso are inclined by 5-10 ° down, the head is turned to the left.

3. Head and torso raised 5-10 ° up, head turned to the right.

4. Head and torso raised 5-10 ° up, head turned to the left

The introduction procedure is facilitated if one medical professional injects a dose of the drug, and the other changes the position of the child’s body and monitors its condition.

First dose
Instillation through a probe with a hole at the end

• Based on the weight of the child and using the table of doses, determine the total dose of the drug Survant^®;
• Slowly draw the entire contents of the bottle into a plastic syringe, using a large needle (at least # 20). PREPARATION OF SURVANT^® DOES NOT REQUIRE FILTERING. DO NOT SHAKE THE PREPARATION;
• Attach the pre-measured French probe number 5 with a hole at the end to the syringe;
• fill the probe with the preparation;
• through the probe, remove excess drug from the syringe so that only the total dose of the drug remains in it;
• before the introduction of the drug Survant^® make sure that the endotracheal tube is properly positioned and passable. At the discretion of the physician, before the administration of the drug, the endotracheal tube can be sucked out. The condition of the child should be stabilized before the introduction of the drug.

In case of using the drug Survant^® for the prevention of RDS, the child must be weighed, intubated and stabilized. The drug should be administered as soon as possible, preferably within 15 minutes from the moment of birth. Lay the baby properly, then gently inject the first part of the dose through the probe for 2-3 seconds.
After the introduction of the first fractional dose, remove the probe from the endotracheal tube. To prevent cyanosis, perform a manual ventilation of the lungs using a hand bag with sufficient oxygen content at a speed of 60 breaths per minute and sufficient positive pressure to ensure adequate gas exchange and chest movement.
When using the drug Survant^® for the treatment of RDS, the first dose should be administered as soon as possible after the child has been connected to the ventilator. Lay the child properly, then gently inject the first fractional dose through the probe for 2-3 seconds. After the introduction of the first fractional dose, remove the probe from the endotracheal tube. Resume artificial respiration. In both cases, artificial respiration must be continued for at least 30 seconds or until the state stabilizes. Then change the position of the child for the next fractional dose.
Similarly install the remaining fractional doses. After the introduction of each fractional dose, remove the probe and perform artificial respiration for at least 30 seconds or until the child’s condition has stabilized. After installing the last fractional dose, remove the probe without flushing it. Within an hour after the injection, do not suck off the contents of the respiratory tract, unless there are signs of significant obstruction of the airways.
AFTER THE END OF THE INTRODUCTION OF THE SURVANT PREPARATION^® CONTINUE ARTIFICIAL VENTILATION OF THE LUNGS IN THE REGULAR REGIME AND CONDUCT THE REGULAR NECESSARY HEALING MANIPULATIONS.
Instillation through the second lumen of the double-lumen endotracheal tube

• Ensure that the child is intubated using a suitable sized, double lumen endotracheal tube;
• based on the weight of the child and using the table of doses, determine the total dose of the drug Survant^®;
• Slowly draw the total dose of the drug into the plastic syringe using a large needle (at least # 20). PREPARATION OF SURVANT^® DOES NOT REQUIRE FILTERING. DO NOT SHAKE THE PREPARATION;
• before the introduction of the drug Survant^® make sure the endotracheal tube is installed correctly. At the discretion of the physician, before the administration of the drug, the endotracheal tube can be sucked out. The condition of the child should be stabilized before the introduction of the drug.

In case of using the drug Survant^® for the prevention of the development of RDS, the child must be weighed, intubated and stabilized. The drug should be administered as soon as possible, preferably within 15 minutes from the moment of birth.Attach a syringe containing Survant^® to the second lumen of the tube. Lay the child properly, then gently enter the first fractional dose through the second lumen of the endotracheal tube for 2-3 seconds without interrupting mechanical ventilation. For manual ventilation to prevent cyanosis, perform artificial ventilation using a hand bag with sufficient oxygen at a speed of 60 breaths per minute and sufficient positive pressure to ensure adequate gas exchange and chest movement.
When using the drug Survant^® for the treatment of RDS, the first dose should be administered as soon as possible after the child has been connected to the ventilator. Immediately before the installation of the first fractional dose, the parameters of the artificial respiration mode should be changed: speed up to 60 / min, inhalation time 0.5 second, FiC₂ - 1.0. Lay the child properly, then gently inject the first fractional dose through a probe for 2-3 seconds through the second lumen of the endotracheal tube, without interrupting mechanical ventilation.
In both cases, artificial respiration must be continued for at least 30 seconds or until the state stabilizes. Then change the position of the child for the next fractional dose.
Similarly install the remaining fractional doses. After the introduction of each fractional dose, remove the probe and perform artificial respiration for at least 30 seconds or until the child’s condition has stabilized. After the last dose has been installed, disconnect the syringe from the second lumen of the endotracheal tube, INPUT 0.5 ML OF AIR TO SEVE THE SECOND CLEARANCE OF THE ENDOTRACHEAL TUBE AND CLOSE IT.
AFTER THE END OF THE ADMINISTRATION OF THE SURVANT® DRUG, CONTINUE THE ARTIFICIAL VENTILATION OF THE LUNGS IN THE REGULAR REGIME AND CONDUCT THE REGULAR NECESSARY HEALING MANIPULATIONS.
Repeated doses
The need for the appointment of repeated doses of Beractant determined by the presence of signs of persistent RDS. The dose is also calculated using table number 1.
Repeated administration of the drug should be carried out no earlier than 6 hours after the previous dose, if the child is still intubated and requires inhalation of a gas mixture containing at least 30% oxygen, to maintain Pa0₂ below or equal to 80 mm Hg.
Before prescribing repeated doses for prophylaxis, radiographic confirmation of the presence of RDS should be obtained.
Prepare Beractant and place the child properly for the introduction of each fractional dose, as described earlier. After the introduction of each fractional dose, remove the probe from the endotracheal tube and perform artificial respiration for at least 30 seconds or until the child’s condition has stabilized.
With the introduction of repeated doses, do not use the ventilation of the lungs hand bag. DURING THE INTRODUCTION OF THE SURVANT PREPARATION^® THE PARAMETERS OF THE MODE OF ARTIFICIAL VENTILATION OF THE LUNGS CAN BE CHANGED BY THE MEANS OF THE DOCTOR TO MAINTAIN ADEQUATE OXYGENATION AND VENTILATION.
AFTER THE END OF THE INTRODUCTION OF THE SURVANT PREPARATION^® CONTINUE ARTIFICIAL VENTILATION OF THE LUNGS IN THE REGULAR REGIME AND CONDUCT THE REGULAR NECESSARY HEALING MANIPULATIONS.
Precautionary measures
If during the administration of the drug a child develops bradycardia or a decrease in oxygen saturation, the procedure should be stopped and appropriate measures taken to improve the child’s condition. After stabilization of the child's condition, resume the procedure.
After the introduction of Beractant in the lungs transient moist rales can be heard. Suction of the endotracheal contents or any other therapeutic manipulations are not required, except for the cases of obvious signs of airway obstruction.

Drug survant^® CAN FASTLY IMPACT ON OXYGENATION AND SURFACE LUNG ACTIVITY. In this regard, the drug should be used only in highly specialized departments, where there are specialists with experience in conducting intubation, mechanical ventilation and care for premature infants. In the appointment of the drug requires frequent monitoring of system indicators of oxygen and carbon dioxide in arterial blood or percutaneous measurement.
DURING THE ADMINISTRATION OF THE PREPARATION, THE OCCASIONS OF TRANSITOR BRADICARDS AND A REDUCTION OF OXYGEN SATURATION HAD BEEN NOTED. If these adverse reactions develop, the procedure should be terminated and appropriate measures taken to improve the condition of the child. After stabilization of the child’s condition, the procedure should be resumed.
General information
No experience with the drug Survant^® in patients with a body weight less than 600 g and more than 1750 g, as well as in combination with other methods of treatment of RDS (for example, high-frequency artificial lung ventilation or extracorporeal membrane oxygenation).
In controlled clinical trials in newborns treated with Survant^®, there was an increased risk of developing nosocomial sepsis. Increased risk of sepsis in children treated with Survant^®, was not associated with an increase in mortality among these children. The pathogens were similar in the group of children treated and in the control group. There were no significant differences between the groups in the incidence of other infectious diseases.

About cases of drug overdose Survant^® not reported. Based on data from animal studies, overdose can lead to acute airway obstruction. In case of overdose, symptomatic and maintenance treatment should be carried out.
After the introduction of the drug Survant^® in the lungs transient moist rales may be heard. Suction of the endotracheal contents or any other therapeutic manipulations are not required, except for the cases of obvious signs of airway obstruction.