Surfactant application during extracorporeal membrane oxygenation improves lung volume and pulmonary mechanics in children with respiratory failure

Hermon, Michael; Burda, Gudrun; Male, Christoph; Boigner, Harald; Ponhold, W; Khoss, A; Strohmaier, Wolfgang; Trittenwein, Gerhard

doi:10.1186/cc3880

Cited by 14 publications

(5 citation statements)

References 17 publications

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“…Among 37 courses of ECMO in which 89 doses of surfactant were administered, our data demonstrate that C dyn increased significantly from 0.340 to 0.450 mL/cm-H 2 0/kg (p < 0.001). This 32% increase in compliance is less than the 76.1% increase after surfactant reported by Hermon et al 19 Our findings are derived from a larger population and multiple measurements of C dyn per epoch, as opposed to three singular measurements (baseline, 4 hours and 10 hours) of C dyn per patient. Both studies support that surfactant may increase C dyn , which may in turn improve outcome.…”

Section: Discussioncontrasting

confidence: 66%

“…18 However, there are scant data describing the administration of surfactant during pediatric ECMO outside the neonatal period. 19 To that end we retrospectively reviewed surfactant administration during pediatric ECMO at our institution, including pertinent outcome variables such as respiratory system compliance, ECMO duration and patient survival. This paper describes 96 courses of ECMO and 89 doses of surfactant administered during 37 of those courses.…”

Section: Introductionmentioning

confidence: 99%

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Surfactant Administration During Pediatric Extracorporeal Membrane Oxygenation

Shein¹,

Maul²,

Kurland

2015

ASAIO Journal

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Administering surfactant during pediatric extracorporeal membrane oxygenation (ECMO) may influence important clinical variables, but has been insufficiently described. Ninety-six courses of ECMO from our center were retrospectively assessed and 89 surfactant doses were identified during 37 ECMO courses. Surfactant administration was associated with a respiratory indication for ECMO, and increased durations of ECMO and positive pressure ventilation. Hospital survival was 64.9% (24/37) in surfactant-treated ECMO courses and 72.9% (43/59) otherwise (p = 0.41). Dynamic compliance of the respiratory system (Cdyn) (shown as least squares mean [standard error] in mL/cm-H20/kg by mixed effects modeling) increased significantly from 0.34 (0.03) before surfactant to 0.40 (0.03) within 12 hours (p = 0.023) and to 0.45 (0.03) within 24 hours (p < 0.001) of surfactant administration. Other mechanical ventilator parameters, ECMO settings and arterial blood gas results did not differ significantly following surfactant administration. Among surfactant recipients, significantly increased Cdyn was observed in the non-surgical group (n=20) but not in the cardiac surgery group (n=17). In conclusion, respiratory system compliance is increased following surfactant administration and non-cardiac surgical patients may preferentially benefit from this therapy. Surfactant administration was associated with longer durations of mechanical support, but not with unfavorable mortality.

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Section: Discussioncontrasting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Surfactant Administration During Pediatric Extracorporeal Membrane Oxygenation

Shein¹,

Maul²,

Kurland

2015

ASAIO Journal

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“…To our knowledge, recent studies on SRT in adult ARDS have not included ECMO patients or included a lung lavage treatment preceding surfactant administration. SRT during ECMO has been studied in pediatric patients and shown to be beneficial [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, the absence of chest wall in the EVLP system may have facilitated lung recruitment with consequent higher exogenous surfactant bioavailability in the alveolar space. Indeed, SRT in combination with lung RM has been shown effective to improve oxygenation and lung volume [ 24 – 26 ]. It would be hence interesting to investigate whether SRT is more effective in ARDS subjects with higher alveolar ‘recruitability’ compared to subjects with persistent lung consolidation.…”

Section: Discussionmentioning

confidence: 99%

Veno-venous ECMO as a platform to evaluate lung lavage and surfactant replacement therapy in an animal model of severe ARDS

Qaqish

Watanabe

Galasso

et al. 2020

ICMx

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Background There are limited therapeutic options directed at the underlying pathological processes in acute respiratory distress syndrome (ARDS). Experimental therapeutic strategies have targeted the protective systems that become deranged in ARDS such as surfactant. Although results of surfactant replacement therapy (SRT) in ARDS have been mixed, questions remain incompletely answered regarding timing and dosing strategies of surfactant. Furthermore, there are only few truly clinically relevant ARDS models in the literature. The primary aim of our study was to create a clinically relevant, reproducible model of severe ARDS requiring extracorporeal membrane oxygenation (ECMO). Secondly, we sought to use this model as a platform to evaluate a bronchoscopic intervention that involved saline lavage and SRT. Methods Yorkshire pigs were tracheostomized and cannulated for veno-venous ECMO support, then subsequently given lung injury using gastric juice via bronchoscopy. Animals were randomized post-injury to either receive bronchoscopic saline lavage combined with SRT and recruitment maneuvers (treatment, n = 5) or recruitment maneuvers alone (control, n = 5) during ECMO. Results PaO2/FiO2 after aspiration injury was 62.6 ± 8 mmHg and 60.9 ± 9.6 mmHg in the control and treatment group, respectively (p = 0.95) satisfying criteria for severe ARDS. ECMO reversed the severe hypoxemia. After treatment with saline lavage and SRT during ECMO, lung physiologic and hemodynamic parameters were not significantly different between treatment and controls. Conclusions A clinically relevant severe ARDS pig model requiring ECMO was established. Bronchoscopic saline lavage and SRT during ECMO did not provide a significant physiologic benefit compared to controls.

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“…As oxygenation improves, tidal volume increases and chest radiographs reveal a reduction in pulmonary opacification. Hermon and coworkers [ 3 ] investigated whether surfactant application could influence these variables in children with respiratory failure. After application of surfactant, mean tidal volume almost doubled (186% of baseline value), mean compliance increased significantly (176% of baseline value) and radiographic scores tended to decrease within 48 hours.…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Year in review 2005: Critical Care - Respirology: mechanical ventilation, infection, monitoring, and education

2006

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We summarize all original research in the field of respiratory intensive care medicine published in 2005 in Critical Care. Twenty-seven articles were grouped into the following categories and subcategories to facilitate rapid overview: mechanical ventilation (physiology, spontaneous breathing during mechanical ventilation, high frequency oscillatory ventilation, side effects of mechanical ventilation, sedation, and prone positioning); infection (pneumonia and sepsis); monitoring (ventilatory monitoring, pulmonary artery catheter and pulse oxymeter); and education (training and health outcome).

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Surfactant application during extracorporeal membrane oxygenation improves lung volume and pulmonary mechanics in children with respiratory failure

Abstract: Introduction This study was performed to determine whether surfactant application during extracorporeal membrane oxygenation (ECMO) improves lung volume, pulmonary mechanics, and chest radiographic findings in children with respiratory failure or after cardiac surgery.

Cited by 14 publications

References 17 publications

Surfactant Administration During Pediatric Extracorporeal Membrane Oxygenation

Surfactant Administration During Pediatric Extracorporeal Membrane Oxygenation

Veno-venous ECMO as a platform to evaluate lung lavage and surfactant replacement therapy in an animal model of severe ARDS

Year in review 2005: Critical Care - Respirology: mechanical ventilation, infection, monitoring, and education

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