Effect of surfactant replacement onPneumocystis carinii pneumonia in rats

Eijking, E. P.; Daal, G. J. van; Tenbrinck, R.; Luijendijk, Ad; Sluiters, J. F.; Hannappel, Ewald; Lachmann, Burkhard

doi:10.1007/bf01690770

Cited by 49 publications

(24 citation statements)

References 17 publications

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“…Exogenous surfactant therapy is similarly beneficial in animals with pneumonia from Pneumocystis carinii, 140 group B streptococcus, 141 and acid aspiration pneumonitis. [142][143][144][145] Direct lung injury from tracheally instilled lipopolysaccharide in animals also responds favorably to exogenous surfactant administration, 146,147 and there was significant favorable response to exogenous surfactant in animals with acute hyperoxic injury relevant for ALI/ ARDS.…”

Section: Animal Studies Of Surfactantmentioning

confidence: 99%

The Future of Exogenous Surfactant Therapy

Willson

Notter

2011

Respir Care

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Since the identification of surfactant deficiency as the putative cause of the infant respiratory distress syndrome (RDS) by Avery and Mead in 1959, our understanding of the role of pulmonary surfactant in respiratory physiology and the pathophysiology of acute lung injury (ALI) has advanced substantially. Surfactant replacement has become routine for the prevention and treatment of infant RDS and other causes of neonatal lung injury. The role of surfactant in lung injury beyond the neonatal period, however, has proven more complex. Relative surfactant deficiency, dysfunction, and inhibition all contribute to the disturbed physiology seen in ALI and acute respiratory distress syndrome (ARDS). Consequently, exogenous surfactant, while a plausible therapy, has proven to be less effective in ALI/ ARDS than in RDS, where simple deficiency is causative. This failure may relate to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution, or simply an inability of the drug to substantially impact the underlying pathophysiology of ALI/ARDS. Both animal and human studies suggest that direct types of ALI (eg, aspiration, pneumonia) may be more responsive to surfactant therapy than indirect lung injury (eg, sepsis, pancreatitis). Animal studies are needed, however, to further clarify aspects of drug composition, timing, delivery, and dosing before additional human trials are pursued, as the results of human trials to date have been inconsistent and largely disappointing. Further study and perhaps the development of more robust pharmaceutical surfactants offer promise that exogenous surfactant will find a place in our armamentarium of treatment of ALI/ARDS in the future. Key words: surfactant; infant respiratory distress syndrome; RDS; acute lung injury; ALI; acute respiratory distress syndrome; ARDS; neonatal. [Respir Care 2011;56(9):1369 -1386.

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Section: Animal Studies Of Surfactantmentioning

confidence: 99%

The Future of Exogenous Surfactant Therapy

Willson

Notter

2011

Respir Care

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“…Aspiration of acid [82][83][84]or meconium [85][86][87][88] Anti-lung serum infusion [89] Bacterial or endotoxin-induced injury [90][91][92][93][94][95] Bilateral vagotomy [96] Hyperoxic lung injury [97][98][99][100][101] In vivo lung lavage with mechanical ventilation [102][103][104][105][106][107] NNNMU-induced lung injury [108][109][110] Viral pneumonia [111,112] NNNMU is N-nitroso-N-methylurethane. See text for discussion.…”

Section: Summary and Future Prospects For Surfactant Therapy In Amentioning

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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“…The surfactant dose instilled corresponds to 20 mg kg-' body weight (b.w.t.) in mice weighing 25 g. The reported surfactant doses for treatment of respiratory failure in subjects with pneumonia are generally several times higher, ranging from 50-300 mg kg-' or more (Gortner et al, 1990;Auten et al,, 1991;Eijking et al, 1991;van Daal et al, 1991;1992;Harms & Herting, 1994). However, these subjects are mechanically ventilated and receive the surfactant dose in a larger instillation volume, 2-4 ml kg-'.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary surfactant as vehicle for intratracheally instilled tobramycin in mice infected with Klebsiella pneumoniae

Veen

Mouton

Gommers

et al. 1996

British J Pharmacology

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1 The use of pulmonary surfactant has been proposed as a vehicle for antibiotic delivery to the alveolar compartment of the lung. This study investigated survival rates of mice with a respiratory Klebsiella pneumoniae infection treated intratracheally with tobramycin using a natural exogenous surfactant preparation as vehicle. 2 At day 1 after infection, animals were injected intratracheally with 20 M1 of the following solutions:(1) a mixture of surfactant (500 ug) and tobramycin (250 pg); (2) tobramycin (250 Mg) alone; (3) surfactant (500 Mg) alone; and (4) NaHCO3 buffer (control, sham-treatment

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Effect of surfactant replacement onPneumocystis carinii pneumonia in rats

Cited by 49 publications

References 17 publications

The Future of Exogenous Surfactant Therapy

The Future of Exogenous Surfactant Therapy

Surfactant for Pediatric Acute Lung Injury

Pulmonary surfactant as vehicle for intratracheally instilled tobramycin in mice infected with Klebsiella pneumoniae

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