Distribution of Exogenous Surfactant in Rabbits with Severe Respiratory Failure: The Effect of Volume

Vanderbleek, J; Fb, Plötz; vanOverbeek, FM; Heikamp, A; Beekhuis, H; Wildevuur, Crh; Okken, A; Oetomo, Sb

doi:10.1203/00006450-199308000-00009

Cited by 76 publications

(37 citation statements)

References 28 publications

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“…At the same time, instilled surfactant volume impacts intrapulmonary drug distribution, which is already compromised by edema and inflammation as noted earlier. Studies in animal models of ALI/ARDS have indicated that the distribution of exogenous surfactant can be improved by instilling larger fluid volumes or utilizing associated bronchoalveolar lavage [151][152][153][154], but the feasibility and/or utility of these approaches in clinical practice is uncertain. Clinical studies on intratracheal or bronchoscopic instillation of exogenous surfactants in patients with ALI/ARDS have used a range of instilled volumes, with doses as high as 300 mg/kg [155] and as low as 25 mg/kg [26].…”

Section: Delivery Methods and Dosages For Exogenous Surfactant Therapmentioning

confidence: 99%

Surfactant for Pediatric Acute Lung Injury

Willson¹,

Chess²,

Notter³

2008

Pediatric Clinics of North America

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SynopsisThis article reviews exogenous surfactant therapy and its use in mitigating acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) in infants, children, and adults. Biophysical and animal research documenting surfactant dysfunction in ALI/ARDS is described, and the scientific rationale for treatment with exogenous surfactant is discussed. Major emphasis is on reviewing clinical studies of surfactant therapy in pediatric and adult patients with ALI/ARDS. Particular advantages from surfactant therapy in direct pulmonary forms of these syndromes are described. Also discussed are additional factors affecting the efficacy of exogenous surfactants in ALI/ARDS, including the multifaceted pathology of inflammatory lung injury, the effectiveness of surfactant delivery in injured lungs, and composition-based activity differences among clinical exogenous surfactant preparations.

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Section: Delivery Methods and Dosages For Exogenous Surfactant Therapmentioning

confidence: 99%

Surfactant for Pediatric Acute Lung Injury

Willson¹,

Chess²,

Notter³

2008

Pediatric Clinics of North America

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“…Several techniques are under investigation: antepartum addition of a combination of thyrotropin-releasing hormone and betamethasone [173], addition of antithrombin III to surfactant (to form a complex with thrombin, thereby neutralizing its effect) [274], dilution of surfactant with a saline solution to obtain a better distribution [312], supplementation with inositol in premature infants to increase survival and decrease retinopathy [111], or a combined treatment of a single dose of surfactant and nasal continuous positive airway pressure [328].…”

Section: Therapeutic Use Of Surfactantmentioning

confidence: 99%

The Pulmonary Surfactant System: Biochemical and Clinical Aspects

Creuwels

Golde

Haagsman

1997

Lung

283

188

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Abstract. This article starts with a brief account of the history of research on pulmonary surfactant. We will then discuss the morphological aspects and composition of the pulmonary surfactant system. We describe the hydrophilic surfactant proteins A and D and the hydrophobic surfactant proteins B and C, with focus on the crucial roles of these proteins in the dynamics, metabolism, and functions of pulmonary surfactant. Next we discuss the major disorders of the surfactant system. The final part of the review will be focused on the potentials and complications of surfactant therapy in the treatment of some of these disorders. It is our belief that increased knowledge of the surfactant system and its functions will lead to a more optimal composition of the exogenous surfactants and, perhaps, widen their applicability to treatment of surfactant disorders other than neonatal respiratory distress syndrome.Key words: Surfactant protein-Pulmonary surfactant-Respiratory distress syndrome. HistoryResearch on surfactant goes back to 1929 when von Neergaard published the first paper about the difference in pressure needed to inflate lungs with air or with liquid [333]. He found that the pressure necessary for filling the lungs with air was higher than when the lungs were filled with liquid. To explain this result he stated that the alveoli were stabilized by lowering the naturally high surface tension of the air/water interface. In 1946 Thannhauser and co-workers reported that lung tissue has a remarkably high content of the lipid dipalmityl lecithin (current name, dipalmitoylphosphatidylcholine)Offprint requests to: Henk P. Haagsman.

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“…Our technique utilized a large volume of surfactant that was initially administered into the lung by gravity, followed immediately by gravity drainage of excess fluid. The rationale behind our technique is that uniform lung distribution of surfactant is facilitated by a large volume [35] while simultaneously removing alveolar debris.…”

Section: Introductionmentioning

confidence: 99%

Lavage Administration of Dilute Surfactant in a Piglet Model of Meconium Aspiration

Meister

Balaraman

Ramirez

et al. 2004

Lung

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Maldistribution of exogenous surfactant may preclude any clinical response in acute lung injury associated with surfactant dysfunction. Our previous studies have shown the effectiveness of surfactant lavage after homogenous lung injury. The present study utilizes a histologically confirmed non-homogeneous lung injury model induced by saline lung-lavage followed by meconium injected into a mainstem bronchus. Piglets were then treated with Infasurf® or Exosurf® by lavage (I-LAVAGE, n = 7; E-LAVAGE, n = 5) or bolus (I-BOLUS, n = 8; E-BOLUS, n = 5), or went untreated (CONTROL, n = 4). Lavage administration utilized a dilute surfactant (35 ml/kg; 4mg phospholipid/ ml) instilled into the lung, followed by gravity drainage. The retained doses of the respective surfactant in the lavage and bolus groups were similar. Results showed that the surfactant distribution was more uniform in the lavage groups compared to the bolus groups. Significant and consistent increases in PaO 2 were observed in the lavage groups compared to the bolus groups and the controls. PaO 2 (mmHg) at 240 min posttreatment: I-LAVAGE = 297 ± 54, E-LAVAGE =280 ± 57; I-BOLUS = 139 ± 31; E-BOLUS = 152 ± 29; C = 119 ± 73 (mean ± SEM). Other improved pulmonary function parameters favored lavage administration. We conclude that better surfactant distribution achieved by lavage administration can be more effective than bolus administration in this type of nonhomogeneous lung injury.

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Distribution of Exogenous Surfactant in Rabbits with Severe Respiratory Failure: The Effect of Volume

Cited by 76 publications

References 28 publications

Surfactant for Pediatric Acute Lung Injury

Surfactant for Pediatric Acute Lung Injury

The Pulmonary Surfactant System: Biochemical and Clinical Aspects

Lavage Administration of Dilute Surfactant in a Piglet Model of Meconium Aspiration

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