Surfactant for Pediatric Acute Lung Injury

Willson, Douglas F.; Chess, Patricia R.; Notter, Robert H.

doi:10.1016/j.pcl.2008.02.016

Cited by 54 publications

(52 citation statements)

References 204 publications

(200 reference statements)

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“…This meant testing BD against the most stringent conditions (i.e., the most relevant age range with distinct characteristics). This adds significantly to the relevance of the data, as these peculiarities lead to differences in terms of epidemiology, prognosis, ventilatory modalities [7], efficacy of surfactant [15,22], and ancillary therapies [23], as well.…”

Section: Discussionmentioning

confidence: 99%

“…Then, multivariate Cox's regressions were performed for the same outcomes adjusting for age, sex, PRISM-III 24 , ARDS type (primary/secondary), and study center. These covariates were chosen because of their epidemiological role [4,14] and their association with the outcomes [11,15,16] by unanimous agreement within the working group. BD definition was inserted in the model and considered to have three categories.…”

Section: Statisticsmentioning

confidence: 99%

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The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Section: Statisticsmentioning

confidence: 99%

The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus

et al. 2013

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“…In addition, several synthetic exogenous surfactants are under clinical study and laboratory research. [16][17][18][19][20][21][22][23][24] …”

Section: A Brief Historymentioning

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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“…23 We fo und in the pre sent study that sur fac tant gi ven in trat rac he ally in early-sta ge pri mary ARDS im pro ved Pa O 2 /Fi O 2 ra ti o. Exo ge no us sur fac tant has be en shown to impro ve sur fac tant func ti ons and sur vi val in term infants and chil dren with ALI and ARDS, however did not ha ve a sig ni fi cant ef fect in adult ARDS pati ents. 24 Ta ut et al ga ve nor mal in ten si ve ca re tre atment and 50 mg/kg in trat rac he al rsp-c sur fac tant to 266 ARDS pa ti ents and conc lu ded that rsp-c sur factant im pro ved oxy ge na ti on and dec re a sed mor ta lity, ir res pec ti ve of the pre dis po sing fac tor. 25 We used a dif fe rent pro te in-con ta i ning sur fac tant in trat rache ally and it was in the sa me gro up with rsp-c, and blo od gas analy sis sho wed that oxy ge na ti on was impro ved in rats.…”

Section: Referencesmentioning

confidence: 99%

The Therapeutic Effects of Methylprednisolone and Surfactant in Acute Respiratory Distress Syndrome in a Rat Model

Doğan¹,

Aykan²,

Atalay³

et al. 2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : To com pa re the ef fi cacy of methy lpred ni so lo ne and sur fac tant in early sta ges of acu te lung in jury in rats and to de ter mi ne whether acu te res pi ra tory dis tress syndro me (ARDS) de ve lop ment and its res ponsi ve ness to me di cal tre at ment co uld be as ses sed by bra in nat ri u re tic pep ti de (BNP) and pro-N type BNP. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : Fo urty rats we re ran domly al lo ca ted in to one of fi ve gro ups, with 8 rep li ca tes. Rats in the ba se li ne gro up (gro up B) we re not sub jec ted to e it her trac he o tomy or ARDS in duc ti on, whe re as rats in sham gro up (gro up N) we re sub jec ted only to trac he o tomy. Af ter trac he o tomy and in duc ti on of ARDS by acid as pi ra ti on, re ma i ning rats (n= 24) we re tre a ted with eit her a sing le do se of methy lpred ni so lo ne (20 mg/kg, gro up M) or sur fac tant (100 mg/kg, gro up S) or left un tre a ted (gro up A). Six ho urs la ter, ar te ri al blo od samp les we re col lec ted for blo od ga ses, BNP, and Pro N-Type BNP me a su re ments. R Re e s su ul lt ts s: : Sham trac he o tomy did not af fect Pa O 2 /Fi O 2 ra ti o, BNP and pro-N type BNP le vels, or the acu te lung in jury (ALI) sco re. ARDS in duc ti on dec re a sed Pa O 2 /Fi O 2 ra ti o by 62% and in cre a sed BNP and pro-N type BNP le vels, as well as ALI sco re by 3.5, 2.3, and 2.4-folds, res pec ti vely. Pa -O 2 /Fi O 2 in gro up A was sig ni fi cantly lo wer than the con trols (p< 0.001). We no ted an in cre a se in Pa O 2 /Fi O 2 with methy lpred ni so lo ne and sur fac tant tre at ment (p< 0.001). Both methy lpred ni so lo ne and sur fac tant tre at ments incre a sed Pa O 2 /Fi O 2 ra ti o and dec re a sed BNP and pro-N type BNP le vels. The re was an in cre a se in BNP in the ARDS gro up (p< 0.001). Com pa red to the ARDS gro up, sig ni fi cant reductions we re ob ser ved in the methy lpred ni so lo ne and sur fac tant gro ups (p< 0.001, p< 0.05). BNP va lu e in gro up M was lo wer than the gro up S (p< 0.05). Pro N-Type BNP in cre a sed in rats of the ARDS gro up (p< 0.001). ALI sco re of the ARDS gro up in cre a sed sig ni fi cantly in compa ri son to the nor mal gro up (p< 0.001). Ho we ver, both tre at ment modalities fa i led to re du ce Pro N-Type BNP and ALI sco re. Blo od Pa O 2 /Fi O 2 ra ti o sho wed ne ga ti ve cor re la ti ons with BNP (r= -0.78, p< 0.001) and pro-N type BNP (r= -0.81, p< 0.001) le vels. C Co on nc c l lu u s si i o on n: : Pa O2/Fi O 2 ra ti o in cre a sed whe re as BNP le vel dec re a sed fol lo wing in tra peri to ne al methy lpred ni so lo ne and in trat rac he al sur fac tant ad mi nis tra ti on in ARDS-in du ced rats. Pa O 2 /Fi O 2 ra ti o and BNP may be con si de red as mar kers du ring tre at ment and fol low-up of pa ti ents with ARDS. K Ke ey y W Wo or rd ds s: : Res pi ra tory dis tress syndro me, adult; bra in nat ri u re tic pep ti de-45; methy lpred ni so lo ne; pul mo nary sur fac tant.Ö ÖZ ZE ET T A Am ma aç ç:...

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Surfactant for Pediatric Acute Lung Injury

Cited by 54 publications

References 204 publications

The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus

The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus

The Future of Exogenous Surfactant Therapy

The Therapeutic Effects of Methylprednisolone and Surfactant in Acute Respiratory Distress Syndrome in a Rat Model

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