Surfactant Replacement in Respiratory Failure Induced by Aspiration of Hydrochloric Acid in Rabbits

Kobayashi, Tsutomu; Ganzuka, M.; Ueda, Takashi; Taniguchi, Jumpei; Murakami, S

doi:10.1007/978-3-642-73305-5_28

Cited by 6 publications

(2 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surfactant replacement without previous lung lavage did not result in a significant improvement in pulmonary function. Dilution and removal of surfactant inhibitors are probably the main mechanisms whereby lung lavage exerts its therapeutic effect (20).…”

Section: Discussionmentioning

confidence: 99%

Lung lavage and surfactant replacement for hydrochloric acid aspiration in rabbits

Kobayashi

Ganzuka

Taniguchi

et al. 1990

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

Hydrochloric acid (0.1 N, 5.0 ml.kg-1 in total) was administered intratracheally to 28 adult rabbits anesthetized with pentobarbital and mechanically ventilated with pure oxygen. When the PaO2 decreased to 14.1 +/- 2.8 kPa (mean +/- s.d.), the PaCO2 increased to 8.9 +/- 2.5 kPa, and the minute ventilation (VE) decreased to 51 +/- 8% of the baseline value, animals were divided into 4 groups. The deteriorated values did not improve in the non-treated (control) animals, whereas the animals treated with lung lavage and surfactant replacement showed a significant increase in PaO2 to 35.1 +/- 12.2 kPa, and maintained lower PaCO2 and larger VE than the controls. These parameters showed no significant improvement with surfactant replacement alone, and deteriorated further with lung lavage alone. The minimum surface tension (gamma min) of the edema fluid that accumulated in the airways after acid administration was 22.5 +/- 1.7 mN.m-1, and was not lowered by adding surfactant preparation (10 mg.ml-1) whose original gamma min was less than 2 mN.m-1. We concluded that surfactant inhibition by edema fluid was a cause of respiratory failure, and that lung lavage followed by surfactant replacement might be of therapeutic value for acid aspiration.

show abstract

Section: Discussionmentioning

confidence: 99%

Lung lavage and surfactant replacement for hydrochloric acid aspiration in rabbits

Kobayashi

Ganzuka

Taniguchi

et al. 1990

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…The pathophysiological rationale of surfactant treatment in newborn infants with meconium aspiration syndrome may substantiated by the finding, that meconium is a potent inhibitor of the surface activity of natural surfactant [59]. Surfactant treatment has been demonstrated to improve gas exchange and lung mechanics in experimental adult respiratory distress syndrome (ARDS; [32,36]). As these findings were confirmed in clinical pilot studies in adults [49,52], surfactant treatment may also be feasible for neonates suffering from ARDS-like disorders.…”

Section: Surfactant For Respiratory Disorders In Term Neonatesmentioning

confidence: 99%

Review article

Gortner

1992

Jpme

View full text Add to dashboard Cite

Natural surfactant (Surfactant TA, Survanta, CLSE, SF-RI 1, Curosurf and human surfactant obtained from amniotic fluid) therapy for RDS in very premature infants has been evaluated in 17 controlled clinical trials. Uniformly intratracheal surfactant administration caused a decreased intensity of mechanical ventilation during the first hours (reduced inspiratory pressure, reduced oxygen requirements) as an immediate effect of surfactant administration. Metanalysis reveals barotraumatic pulmonary complications mainly, pneumothorax and pulmonary interstitial emphysema to occur less frequently in surfactant-treated infants in virtually all trials; an increased incidence of survival without bronchopulmonary dysplasia following surfactant treatment was observed in 10 controlled clinical trials. The incidence of other complications of prematurity (intracranial hemorrhage, patent ductus arteriosus and necrotizing enterocolitis) was unchanged following natural surfactant treatment. Dosing of natural surfactant is still under investigation, however recent data indicate that the initial dose should not be less than 100 mg/kg b.w. and retreatment should be given to infants with unsatisfactory response (i.e. fraction of inspired oxygen (FiO2) > 40%). Timing of surfactant treatment still remains controversial. Prophylactic treatment shortly following birth has been compared with rescue-treatment, i.e. surfactant administration to infants suffering from manifest RDS in most studies 4-8 h after birth. Conflicting data from 5 controlled trials may be interpreted as follows: prophylactic treatment seems to be favourable for extremely premature infants (GA < or = 26 weeks) and rescue treatment seems to be adequate for infants of 27-30 weeks of gestation. Intratracheal surfactant instillation in very premature infants did not result in an improved lung function for 24 h to 48 h in all patients. Ten--25% of study infants were reported to be "non-responders", i.e. infants without sustained decrease in oxygen requirements (i.e. FiO2 > 40%). Various factors may be operative including congenital bacterial infections (sepsis or pneumonia), lung hypoplasia and cardiac failure. Inactivation of surface properties of natural surfactant caused by a leakage of proteins across the alveolar-capillary membrane was observed in experimental and clinical studies. Current investigations focus on a combination of postnatal steroids and surfactant treatment to improve lung function and outcome in "non-responders". As long as any controlled clinical studies are being published, this approach remains experimental. Up to now, any controlled clinical trials have been performed to assess different modes of artificial ventilation (e.g. high frequency oscillating ventilation versus conventional ventilation) combined with surfactant therapy. Data obtained from premature animals given natural surfactant indicate any advantage with respect to gas exchange and lung histology to result from high frequency ventilation.(ABSTRACT TRUNCATED AT 400 WORDS)

show abstract

Oxygen Uptake in the Lungs under Pathological Conditions and its Therapeutic Effects

Gommers

Daal

Lachmann

1992

Oxygen Transport to Tissue XIV

View full text Add to dashboard Cite

Surfactant Replacement in Respiratory Failure Induced by Aspiration of Hydrochloric Acid in Rabbits

Cited by 6 publications

References 23 publications

Lung lavage and surfactant replacement for hydrochloric acid aspiration in rabbits

Lung lavage and surfactant replacement for hydrochloric acid aspiration in rabbits

Review article

Oxygen Uptake in the Lungs under Pathological Conditions and its Therapeutic Effects

Contact Info

Product

Resources

About