High‐frequency jet ventilation and surfactant treatment of newborns with severe respiratory failure

Davis, Jonathan M.; Richter, Susan E.; Kendig, James W.; Notter, Robert H.

doi:10.1002/ppul.1950130209

Cited by 59 publications

(26 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, studies indicate that the distribution and/or efficacy of instilled exogenous surfactant can be improved by jet ventilation [161,162] and partial liquid ventilation [163][164][165]. Additional mechanism-based research on the impact of specific ventilation methods and strategies on the delivery, distribution, and efficacy of exogenous surfactants may be important for optimizing this therapy in ALI/ARDS.…”

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…This variability in response to exogenous surfactant could be secondary to the timing of surfactant administration or to the preparation of surfactant used. Davis and colleagues 77 have observed improved oxygenation and ventilation in a small group of infants with MAS who were treated with a combination of high-frequency jet ventilation and calf lung surfactant extract replacement after deterioration in respiratory status while receiving conventional mechanical ventilation and exogenous surfactant therapy. The importance of surfactant function in infants with MAS has been partly elucidated by Bui et al 78 who demonstrated a dramatic increase in phospholipid, disaturated phosphatidylcholine, and SP-A levels in the tracheal aspirate of infants on extracorporeal membrane oxygenation for respiratory failure just before the cessation of oxygenation.…”

Section: Mas and Surfactantmentioning

confidence: 99%

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Fuloria

Wiswell

1999

J Perinatol

View full text Add to dashboard Cite

The term meconium was originally coined by Aristotle who used the Greek word meconium-arion 1 meaning "opium-like," because he believed meconium induced fetal sleep. It is probable that he recognized the association between the presence of meconium in the amniotic fluid and the occurrence of fetal deaths and neonatal depression.Depending on the population studied, the frequency of meconium-stained amniotic fluid (MSAF) at the time of delivery is variable, ranging between approximately 8% and 19% of all term deliveries. [2][3][4][5][6][7][8] Alexander and colleagues 9 noted a 1.5-fold increased risk for MSAF in black women compared with white women. The authors recommended that maternal ethnicity be viewed as a risk indicator of, and not a causal factor for, MSAF. They also observed an increased likelihood of MSAF with increasing gestational age in both ethnic groups.Regardless of the reason for meconium passage, its presence may be associated with adverse fetal and neonatal outcomes, including death, acute respiratory complications, and long-term pulmonary and neurologic abnormalities. Depending on various factors, including the population studied and the criteria used for making a diagnosis, meconium aspiration syndrome (MAS) will develop in 2% to 33% of infants born through MSAF. 3,4,10,11 As many as 30% or more of infants with MAS require mechanical ventilation. 3,12 Accompanying persistent pulmonary hypertension of the newborn (PPHN) is present in approximately one-third of these infants. 13 The mortality associated with MAS is disturbingly high, ranging from 4% to 19% 3,12,14 ; a large proportion of this mortality is attributable to PPHN.Early-onset neonatal seizures, secondary to hypoxic events, have been reported in infants born through thick MSAF. 15 Berkus et al. 16 observed a sevenfold increased risk of neonatal seizures and a fivefold increased likelihood of hypotonia in infants born through moderate to thick compared with thin meconium-stained or clear amniotic fluid. Some investigators have noted an increased likelihood of cerebral palsy in surviving infants with a low Apgar score who were born through MSAF. 17 In addition, there may be long-term pulmonary sequelae associated with MAS. Yuksel et al. 18 have shown increased functional residual capacity and airway reactivity at 6 months of age in infants with MAS; infants who required more respiratory support in the neonatal period had significantly more symptoms and required bronchodilator therapy more often. MAS has also been implicated in increased airway reactivity and abnormal pulmonary function tests in later childhood. 19,20 PATHOPHYSIOLOGY OF MECONIUM PASSAGEMeconium is a viscous green substance composed primarily of water (72% to 80%). Other components of meconium include gastrointestinal secretions, bile, bile acids, mucus, pancreatic juice, cellular debris, and swallowed amniotic fluid, lanugo, vernix caseosa, and blood. 1,21 The substance may first be noted in the fetal gastrointestinal tract as early as 10 to 16 weeks' gestation. At birt...

show abstract

“…Several investigators have the total protein level and surface tension. Surfactant reported anecdotal experience with surfactant therapy in therapy resulted in elevation of airway phospholipid lev-human neonates with severe MAS (6,7,12). In these els but no decrease of the surface tension.…”

Section: Resultsmentioning

confidence: 99%

“…hypertension with either hyperreactive or remodeled pulmonary vasculature (increased muscular wall thickness) (15). Furthermore, we treated early in the course of the disorder (1 h after meconium), whereas human infants have been treated at 24-48 h of age (6,7,12). The nature of the disorder may be very different after that amount of time and may be responsive to surfactant.…”

Section: Resultsmentioning

confidence: 99%

“…These investigators used the standard doses received by premature infants with respiratory distress syndrome. Davis et al (7) found the combination of JET and exogenous surfactant to result in a sustained improvement in oxygenation in 13 neonates with MAS. In a piglet model of MAS, we found less severe pathologic alterations with JET compared with conventional mechanical ventilation (8).…”

Section: Mas Meconium Aspiration Syndromementioning

confidence: 99%

See 1 more Smart Citation

Surfactant Therapy and High-Frequency Jet Ventilation in the Management of a Piglet Model of the Meconium Aspiration Syndrome

et al. 1994

Pediatr Res

View full text Add to dashboard Cite

California 9581 7 (T.A.M.]In vitro data have shown a concentration-dependent inhibition of surfactant by meconium, while anecdotal reports demonstrate improved oxygenation after surfactant replacement in babies with meconium aspiration syndrome, particularly in conjunction with high-frequency jet ventilation. We randomized 70 newborn piglets to either conventional or high-frequency jet ventilation, followed by insufiation of 3 m W g of a 33% meconium solution. Each group was further randomized to one of five surfactant therapies: 1) control, 2) 4 m u g Survanta, 3) 8 m u g Survanta, 4) 5 m u g Exosurf, or 5) 10 m W g Exosurf. We followed arterial blood gases and ventilator requirements over 6 h of ventilation. Aspirates of airway fluids were obtained for surface tension measurements, as well as total protein and phospholipid concentrations. Using a previously established scoring system, a pathologist blinded to treatment evaluated four sections of lung per animal for histologic changes of meconium aspiration syndrome. There were no differences noted between groups in any physiologic parameter measured (mean airway pressure, arterial partial pressure of oxygenlalveolar partial pressure of oxygen ratio, etc.) during the 6 h of ventilation. Airway fluid aspirate total protein concentrations increased significantly after meconium instillation (4-to 5-fold,p < 0.007) and remained elevated in spite of surfactant therapy. There was an initial decline in airway phospholipid concentraThe MAS is a major cause of respiratory distress among neonates (20 000-30 000 babies are affected annu-

show abstract

High‐frequency jet ventilation and surfactant treatment of newborns with severe respiratory failure

Cited by 59 publications

References 20 publications

Surfactant for Pediatric Acute Lung Injury

Surfactant for Pediatric Acute Lung Injury

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Surfactant Therapy and High-Frequency Jet Ventilation in the Management of a Piglet Model of the Meconium Aspiration Syndrome

Contact Info

Product

Resources

About