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There are three different modes of administration of surfactant: direct bolus instillation into the distal end of the tracheal tube via suctioning catheter; via nebuliser in the ventilated gases; and selective bronchial instillation.
The most uniform distribution of surfactant after instillation is obtained during a brief period of manual ventilation (2-3 minutes) accompanied by respiratory physiotherapy and postural drainage.
Administration of bolus surfactant in 2-4 divided doses avoids deterioration in gas exchange and stimulation of vagal reflexes. The airways are not suctioned for the first hour after surfactant administration, in order to avoid the elimination of surfactant.