Pulmonary Surfactant In Treatment Research Articles

Cuban Exogenous Pulmonary Surfactant in Treatment of Pediatric Acute Respiratory Distress Syndrome

ABSTRACT INTRODUCTION Acute respiratory distress syndrome is a complex heterogeneous disorder with low incidence but high case fatality in children. Treatment with pulmonary surfactants is a possible option. Surfacen, a Cuban exogenous pulmonary surfactant, has been proven safe and effective in premature newborns with hyaline membrane disease, but evidence regarding its efficacy in older children is still inconclusive. OBJECTIVE Determine Surfacen’s efficacy in improving oxygenation and increasing survival in children with acute respiratory distress syndrome. METHODS A multicenter (five pediatric intensive care units in four provinces), open-label, controlled, randomized phase III clinical trial with two treatment groups was conducted from November 2009 through August 2013, with 19 girls and 23 boys aged 1 month to 18 years. The experimental group (20 patients) received conventional treatment (oxygenation and mechanical ventilation) plus intratracheal instillation of Surfacen (100 mg/4 mL) every eight hours for three days. The control group (22 patients) received only conventional treatment. The primary dependent outcome was patient vital status (alive or deceased) 28 days after study enrollment. Other variables and outcomes analyzed were age, sex, ARDS presentation, Kirby index (arterial oxygen tension over inspired oxygen fraction), oxygenation index, static lung compliance, transcutaneous oxygen saturation, radiographic course, mechanical ventilation time and length of stay in neonatal intensive care. Statistical tests used were the chi-square test and Fisher exact test. RESULTS On day 28, there was 80% survival in the experimental group versus 38.1% in the control group. There were significant differences between the experimental and the control group in Kirby index, oxygenation index, static lung compliance and radiographic course, all favoring the experimental group. For every 2.38 patients treated in total, there was one additional survivor in the experimental group. CONCLUSIONS When combined with conventional therapy in the regimen employed, Surfacen improves oxygenation and increases survival in children with ARDS.

Cuban Exogenous Pulmonary Surfactant in Treatment of Pediatric Acute Respiratory Distress Syndrome.

Cuban Exogenous Pulmonary Surfactant in Treatment of Pediatric Acute Respiratory Distress Syndrome.

The clinical effect of pulmonary surfactant in treatment of preterm children respiratory distress syndrome

Objective To discuss the clinical effect of pulmonary surfactant in the treatment of preterm children respiratory distress syndrome (RDS).Methods 86 RDS premature children were randomly divided into two groups by digital number table methods,43 cases were in each group,the control group was given nasal continuous positive airway pressure (NCPAP) treatment,while the observation group was given intratracheal instillation PS on the basis of the control group.The arterial blood gases,outcome indicators of changes in circumstances were compared between the two groups.Results After treatment,the PaO2 and PaO2/FiO2 of the observation group were (67.10 ±3.88) mmHg and (191.30 ± 10.72) higher than (43.81 ± 3.78) mmHg and (81.71 ± 5.34) of pre-treatment and (53.35 ± 3.86) mmHg and (126.88 ± 8.50) of the control group (t =9.35,9.50,7.34,7.20,all P ＜ 0.05) ; while PaCO2 was (37.38 ± 3.65) mmHg significantly lower than (59.15 ± 4.27) mmHg of pre-treatment and (58.76 ±3.86) mmHg of the control group,the differences were statistically significance (t =10.15,7.62,all P ＜0.05);after treatment,the IVH and ROP incidence of the observation group were 4.65％ and 6.98％,which were significantly lower than 13.95％ and 16.28％ of the control group (x2 =7.68,7.39,all P ＜ 0.05) ; while the two groups showed no significant difference in incidence of BPD (P ＞ 0.05).Conclusion Pulmonary surfactant in the treatment of respiratory distress syndrome in premature children has significant effect,and it can improve lung function in children with disease outcome and prognosis. Key words: pulmonary surfactant; respiratory distress syndrome ; disease outcome

Clinical analysis of pulmonary surfactant in treatment of 30 cases with neonatal respiratory distress syndrome

Objective To explore the effect of pulmonary surfactant(PS) in the treatment of neonatal respiratory distress syndrome(NRDS).Methods According to whether using the PS,60 NRDS patients were divided into treatment group and control group.The blood-gas analysis index,oxygen time,mechanical ventilation time,hospitalization time and other indicators were analyzed.Results After 6h treatment,blood pH value (7.41 ± 0.11),PaO2 (69.8 ± 11.9) mm Hg and PaCO2 (48.7 ± 11.1)mm Hg in the treatment group were higher than those of the control group (7.24 ±0.13),(53.3 ±9.8)mm Hg,(59.1 ± 12.7)mm Hg(t =3.35,2.88,3.24,all P ＜0.05).In the treatment group,oxygen time (98.2 ± 29.2) h,the time of mechanical ventilation (77.6 ± 30.4) h and hospitalization time (12.9 ± 1.7)d,were also shorter than those of the control group (143.9 ± 26.5) h,(121.4 ± 22.9) h,(17.6 ±2.1) d (t =4.56,5.32,4.86,all P ＜ 0.05).Conclusion The application of PS in the treatment of NRDS can improve the lung function and lung aeration and reduce the time of mechanical ventilation. Key words: Pulmonary surfactants ; Respiratory distress syndrome; Infant, neonate

Effects of pulmonary surfactant in treatment of acute lung injury after cardiac surgery in infants

Acute lung injury is a severe complication after cardiac surgery performed with cardiopulmonary bypass in infant patients. Pulmonary surfactant has been successfully used in treating neonatal respiratory distress syndrome for many years. This study focused on exploring the clinical efficacy of exogenous pulmonary surfactant in treating infant patients with acute lung injury after cardiac surgery with the use of extracorporeal circulation. Twenty-three infants with ventricular septal defect (VSD) were enrolled in the study. None of the patients needed oxygen treatment nor ventilation before heart surgery. VSD repair operation was done under cardiopulmonary bypass, and acute lung injury was found postoperatively. Ten infant patients in the treatment group were given pulmonary surfactant by tracheal instillation during mechanical ventilating postoperatively. Thirteen patients in control group were randomly selected in the same period in hospital, and acute lung injury was diagnosed without pulmonary surfactant treatment after cardiopulmonary bypass. Blood samples were obtained from all the patients, and blood gas analysis was performed every 6 hours. Demographics (body weigh, age, gender, VSD diameter) and clinical characteristics (CPB time, oxygenation index, mean airway pressure, pH and PCO2) of all the patients were collected, and statistical analysis was done to compare the data between treatment and control group. In the first 24 hours after heart surgery, compared with the control group, a more increased oxygenation index (from 89.36 ± 12.69 to 285 ± 16.51) was observed in treatment group, and it was from 93.71 ± 11.82 to 133 ± 19.62 in the control group. There was a significant difference in oxygenation index between the two groups (P < 0.05). At the same time, the MAP (from 17.5 ± 3.18 to 10.4 ± 3.37) of the patients in comparison with the control group (from 18.2 ± 2.63 to 13.8 ± 2.55), a more significantly decreased MAP was observed in the treatment group (P < 0.05). There was no significant difference in pH and PCO2 between the two groups. The ventilation time in cardiac care unit was shorter in treatment group (17.43 ± 9.12) h compared with the control group [(30.97 ± 14.85) h, P < 0.05]. ICU stay time of treatment group (3.90 ± 1.34) d was shorter than that of control group [(6.18 ± 1.90) d, P < 0.05].Two infants of the control group died, but none in treatment group died. In this study, a satisfactory curative effect was observed for the treatment of acute lung injury with PS intratracheal instillation after heart surgery under cardiopulmonary bypass in infant patients. It can reduce the duration of mechanical ventilation and cardiac care unit stay and improve prognosis. In addition, this study was a pilot study and the limited sample size was probably the cause of insufficient statistical power. Further study of larger scale is needed.

Clinical nursing of pulmonary surfactant in treatment of premature babies with respiratory distress syndrome

Objective To investigate the therapeutic effect and nursing ways of pulmonary surfactant in premature babies with respiratory distress syndrome. Methods From July 2008 to January 2011,63 cases of premature babies with respiratory distress syndrome were admitted to our department, pulmonary surfactant was dripped through trachea into these patients, the treatment effect after medication was observed. Results Among these premature babies, one case died of respiratory failure, one case died from pulmonary hemorrhage, sixty-one cases were cured, the cure rate was 96.8%. After treatment, the arterial blood pH, partial pressure of oxygen(PaO2) and oxygen saturation(SaO2) of the 61 patients was significantly higher than before treatment, the arterial blood partial pressure of carbon dioxide (PaCO2)、 total carbon dioxide (TCO2)、actual bicarbonate (AB)was significantly lower than before treatment. Conclusions Pulmonary surfactant combined with appropriate nursing ways is able to cure premature babies with respiratory distress syndrome effectively. Key words: Pulmonary surfactant; Premature baby; Respiratory distress syndrome; Blood gas analysis

Effects of different ventilation modes on efficacy of exogenous pulmonary surfactant for treatment of rats with ventilator-induced lung injury

Objectlve To investigate the effects of different ventilation modes on the efficacy of exogenous pulmonary surfactant(PS)for the treatment of rats with ventilator-induced lung injury(VILI).Methods Forty-two male Wistar rats weighing 310-356 g were randomly divided into 6 groups(n=7 each):group CVT6,group SVT6,group CVT10,group SVT10,group CVT14 and group SVT14.The tidal volume(VT)was set at 6,10 and 14 ml/kg respectively and the respiratory rate(RR) was 75,45 and 32 bpm respectively.The animals were anesthetized with intraperitoneal 3% Pentobarbital 50 mg/kg,then tracheostomized and intubated.VILI model was induced by high-pressure ventilation (HPV) with peak inspimtory pressure (PIP) 40 cm H2O and without positive end-expiratory pressure (PEEP).The air was injected into the trachea via the airway at the end ofexpiration before HPV (T0,baseline value) and 15-25 min of HPV,the airway pressure monitored and the lung compliance(C) calculated.When C was decreased to half of the baseline value,PEEP was increased to 7.5 cm H20.After the tracheal edema fluid was removed,the PS 100 mg/kg was immediately injected into the trachea in group SVT6,SVT10 and SVT14.The equal volume of air was injected into the trachea in group CVT6,CVT10 and CVr14 instead of PS.Then the rats in different groups were ventilated with the corresponding ventilation modes.MAP was monitored and blood samples were token from femoral artery for blood gas analysis at T0, 5 min after HPV (T1 ), and 15, 30, 60, 90, 120 min (T2-6) after administration of PS. The tracheal edema fluid was collected at T1 and T6.The rats were killed at T6 and the lung tissues taken for microscopic examination. Results With the same ventilation mode, the VILI was significantly alleviated after administration of PS. With different ventilation modes,the lung injury was significantly reduced in group SVT 10 compared with the other groups. Conclusion The efficacy of PS for the treatment of rats with VILI is good using the ventilation strategy with VT of 10 ml/kg and RR of 45 bpm. Key words: Pulmonary surfactant-associated protein B; Pulmonary surfactant-associated protein C; Respiratory distress syndrome, adult; Respiration, artificial

Dry powder nebulization of a recombinant surfactant protein C-based surfactant for treatment of acute respiratory distress syndrome

Nebulization of pulmonary surfactant for treatment of ARDS represents a desirable therapeutic approach but was hitherto impossible under clinical conditions due to the technical limitations of currently available devices. In the present study we investigated a new dry powder nebulizer for administration of a recombinant surfactant protein C (rSP-C)-based surfactant.