Surfactant composition reflects lung overinflation and arterial oxygenation in patients with acute lung injury

Bersten, Andrew D.; Doyle, IR; Davidson, K; Barr, HA; Nicholas, TE; Kermeen, F.

doi:10.1183/09031936.98.12020301

Cited by 23 publications

(11 citation statements)

References 30 publications

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“…The changes in phospholipid profile observed in patients with sepsis-associated ARDS were very similar to those in patients with trauma-induced lung injury [54,56]. A close inverse correlation between the phosphatidylcholine concentration and respiratory failure score [55] or arterial oxygenation [98] was observed. The ratio between SAs and the more surface active LAs was significantly increased in patients with ARDS in comparison to non-ARDS patients [24].…”

Section: Obstructive Lung Diseasessupporting

confidence: 53%

Increased expression of apoptosis signalling receptors by alveolar macrophages in sarcoidosis

Dai¹,

Guzman²,

Costabel³

1999

Eur Respir J

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Section: Obstructive Lung Diseasessupporting

confidence: 53%

Increased expression of apoptosis signalling receptors by alveolar macrophages in sarcoidosis

Dai¹,

Guzman²,

Costabel³

1999

Eur Respir J

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“…5B), in accordance with the report of Miranda et al in which the sphingomyelin content of these same tissues was determined by the phosphate combustion method (22). The tissue with the highest sphingomyelin concentration (both normal and NPD) was the lung, perhaps due to the presence of lung surfactants which are known to be rich in this and other phospholipids (33), and the massive infiltration of lipid-filled macrophages into the airways of the NPD animals.…”

Section: Figmentioning

confidence: 59%

An Enzymatic Assay for Quantifying Sphingomyelin in Tissues and Plasma from Humans and Mice with Niemann–Pick Disease

Chen

Gátt

et al. 2001

Analytical Biochemistry

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“…This was taken as representative of the baseline lung function. The plasma and pulmonary surfactant data are reported elsewhere [16].…”

Section: Methodsmentioning

confidence: 99%

Measurement of overinflation by multiple linear regression analysis in patients with acute lung injury

Bersten¹

1998

Eur Respir J

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aaAcute lung injury (ALI) results in an increase in permeability, recruitment of neutrophils and impairment of the surfactant system. Although increased permeability in patients with the acute respiratory distress syndrome (ARDS) is evenly distributed across the lung [1], regional lung inflation is markedly heterogeneous [2,3]. Increased lung weight tends to collapse a dependent lung, while nondependent lung is more normally aerated. Since a relatively small lung is ventilated, excessive tidal volumes could overdistend some alveoli and produce further lung injury.In order to prevent overdistension, current recommendations target ventilatory plateau pressures <30-35 cmH 2 O [4,5], since total lung capacity is normally achieved at this level of transalveolar pressure. However, the end-inspiratory lung volume (VEI), rather than the airway pressure (Paw), appears to determine whether lung injury occurs [6]. This was confirmed in a recent clinical study where up to 90% of ARDS patients showed evidence of overinflation below a plateau pressure of 35 cmH 2 O [7].Static volume-pressure curve analysis has been used to define lung overinflation, with the upper inflection point denoting a sudden increase in elastance with further inflation. However, static techniques are not widely used. Since a prolonged pause is needed for equilibration of gas flow and respiratory muscle activity may also result in an unstable end-expiratory lung volume (EELV), the subject must be paralysed. If a super-syringe technique is used allowance must be made for the continuing gas exchange [8] and patients may develop hypoxaemia. Finally, respiratory mechanics are only described at a single point in a continually evolving process.Dynamic volume-pressure curve analysis offers online, potentially continuous, measurements that do not interfere with ventilation and produce a "functional" description of lung mechanics [9]. Dynamic data may also reflect the contribution of heterogeneous time constants to lung overinflation. At a given respiratory rate short time constant lung units will receive proportionately more ventilation than long time constant lung units, possibly contributing to regional overinflation [10]. This effect would not be detected by static volume-pressure curve analysis, but would contribute to both dynamic curve changes and possibly to ventilator-induced lung injury.Models for estimating overinflation from dynamic volume-pressure curves, by partitioning dynamic respiratory elastance (Ers,dyn) into volume-independent (E 1 ) and volume-dependent (E 2 ) components [11][12][13], have only recently been described. However, this technique has not been Measurement of overinflation by multiple linear regression analysis in patients with acute lung injury. A.D. Bersten. ERS Journals Ltd 1998.ABSTRACT: Strategies to optimize alveolar recruitment and prevent lung overinflation are central to ventilatory management of patients with acute lung injury (ALI). The recent description of overinflation using multilinear regression analysis of airway...

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Surfactant composition reflects lung overinflation and arterial oxygenation in patients with acute lung injury

Cited by 23 publications

References 30 publications

Increased expression of apoptosis signalling receptors by alveolar macrophages in sarcoidosis

Increased expression of apoptosis signalling receptors by alveolar macrophages in sarcoidosis

An Enzymatic Assay for Quantifying Sphingomyelin in Tissues and Plasma from Humans and Mice with Niemann–Pick Disease

Measurement of overinflation by multiple linear regression analysis in patients with acute lung injury

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