End-tidal CO(2) (PetCO(2)) was measured for 1-minute pre- and post-arterial blood sampling, and PetCO(2) and PaCO(2) were compared for each patient. Administration of exogenous surfactant may at least partially alleviate the inactivation of pulmonary surfactant present in meconium aspiration syndrome. Exogenous lung surfactants are among the most studied drugs in medicine. Found insideThis book covers the whole spectrum of intensive care in childhood. It is based on the experience of leading specialists in the various fields involved in the treatment of these children. Therapeutic protocols usually include airway suctioning, ventilator support or artificial ventilation, in severe cases also administration of exogenous surfactant, inhaled NO, partial liquid ventilation, or anti-inflammatory treatment. Objectives: To determine the effect of multiple doses of exogenous surfactant compared to single doses of exogenous surfactant on mortality and complications of prematurity in premature infants at risk for or having respiratory distress syndrome. Infants were excluded if any other cause was found to explain their deterioration. Prior in vitro work has shown that poly-N . Surfactant therapy then seems to work well when used in conjunction with antenatal steroid therapy. Froese AB, McCulloch PR, Sugiura M, Vaclavik S, Possmayer F, Moller F. Optimizing alveolar expansion prolongs the effectiveness of exogenous surfactant therapy in the adult rabbit. There is every reason to aspiración meconial (SAM), la neumonía congénita y el síndrome de distrés respiratorio del adulto (SDRA) demostraron mejoría en la oxigenación, reducción de la necesidad de ventilación asistida, así como disminución del tiempo de hospitalización [1][2][3][4], ... Desde 1959, cuando Avery y Mead sugirieron que la dificultad respiratoria de los recién nacidos prematuros se debía al déficit de surfactante, se han realizado numerosos estudios en esta área, habiendo evidencias que apoyan la teoría de que el surfactante tiene un papel pluripotencial, importante en el normal funcionamiento de los pulmones 2,3 . Consequently, exogenous surfactant, while a plausible therapy, has proven to be less effective in ALI/ARDS than in RDS, where simple deficiency is causative. Although neonatal RDS is still the main indication of surfactant therapy, other pathological processes database. ... 22,23,[27][28][29] Meta-analysis of clinical trials in which synthetic or natural surfactant was used, either as a prophylactic or rescue treatment, clearly supports these findings. (E,n . No patient deteriorated following surfactant therapy. Exogenous-surfactant replacement has been successfully achieved in IRDS 7, but clinical trials in ARDS have had mixed results. This site needs JavaScript to work properly. Alternative administration strategies include the use of surfactant bolus divided into several portions, ... stilled liquid dose of surfactant in suspension deliv- 53 ered via an endotracheal tube (, ... First attempts in RDS treatment have been made with glucocorticoids and other anti-inflammatory drugs [30]. Because surfactant dysfunction plays a role in the pathogenesis of pneumonia, beneficial effects can be expected from exogenous surfactant therapy. Randomized controlled trials have demonstrated the efficacy of surfactant therapy in the treatment of infants at risk for or having respiratory distress syndrome (RDS). To compare the complications among preterm infants treated with two different natural surfactants. SP-D participates in the innate immune defense of the lungs by helping to clear infectious pathogens and modulating the immune response. Newborns in the pulmonary group (n=13) (persistent pulmonary hypertension of the newborn/meconium aspiration syndrome, respiratory distress syndrome, pneumonia) and newborns in the control group (n=7) were matched for birth weight, gestational age, and postnatal age. This book presents a concise, evidence-based review of extracorporeal life support (ECLS) for adult diseases. Four experimental surfactant preparations were prepared by mixing 1% dSP-B(1-25), 2% dSP-B(1-25), 1% dSP-B(1-25) +1% SP-Cfc, and 2% dSP-B(1-25) +1% SP-Cfc with phospholipids (PL). Since the available data are extremely limited, if this potential therapeutic approach will be considered valid in the clinical practice, the necessary future investigations should aim to identify the best dose, administration route (oral, intravenous and/or aerosol nebulization), and cluster(s) of patients which may get beneficial effects from this treatment. in their management, Meconium aspiration syndrome (MAS) and congenital pneumonia are two worthy One study of multiple vs. single dose synthetic surfactant in infants at high risk of respiratory distress syndrome was identified. We report successful treatment of RDS with exogenous surfactant (TA). Objectives: To determine the effect of multiple doses of exogenous surfactant compared to single doses of exogenous surfactant on mortality and complications of prematurity in premature infants at risk for or having respiratory distress syndrome. Yet, efforts to treat ARDS patients with liquid instillations of exogenous surfactant have so far failed. This book presents lung ultrasound as an accurate, reliable, low-cost and simple imaging technique, which poses no risk of radiation damage, making bedside use both feasible and convenient in neonatal wards. However, because haemoglobin and other blood components such as fibrinogen have been shown to have serious adverse effects on surfactant function [31] , surfactant replacement therapy has also been used to treat pulmonary hemorrhage. The mean duration of need for oxygen and hospitalization of patients in group A and B were 17.73+/-22.25 vs 19.14+/-17.85 days (p=0.67) and 24.89+/-26.41 vs 29.14+/-23.54 days (p= 0.32), respectively. ResearchGate has not been able to resolve any references for this publication. M. Moreno 1, J. López-Herce 1, C. Merello 1, A. Alcaraz 1 & A. Carrillo 1 Intensive Care Medicine volume 22, page 87 (1996)Cite this article Consequently, exogenous surfactant, while a plausible therapy, has proven to be less effective in ALI/ARDS than in RDS, where simple deficiency is causative. However, Lu et al. 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. One of the ongoing challenges in surfactant therapy is obtaining a homogeneous distribution of surfactant within the lungs despite an inherent tendency to non-uniform . Comparison of Polymyxin E and Polymyxin B as an Additive to Pulmonary Surfactant in Escherichia coli Pneumonia of Ventilated Neonatal Rabbits. Initial preliminary reports, mainly phase-II multicentre trials, have shown that exogenous artificial surfactant (Exosurf®) 18 or bovine surfactant (Survanta®) 19 in ARDS can improve oxygenation and lung mechanics. In surfactant-deficient conditions the amount of airway closure increased approximately three-fold. Eight quantitative waveform parameters were also measured on all patients. Surfactants used in this manner are typically instilled directly into the trachea. with some success; nonetheless, further improvements are very much in need. Surfactant therapy is currently a mainstay in neonatal care, where its use has been associated with a significant reduction in the morbidity and mortality accompanying premature birth. In experimental and clinical studies, intratracheal administration of a surfactant bolus significantly improved both lung function and survival. Stichtenoth G, Haegerstrand-Björkman M, Walter G, Linderholm B, Herting E, Curstedt T. Biomed Hub. Its introduction into neonatal practice in the early 1990s With the increasing use of non-invasive ventilation as the primary mode of respiratory support for preterm infants at delivery, prophylactic surfactant is no longer beneficial. Group A consisted of 79 neonates that received poractant (curosurf). A repeat dose of surfactant may be required in these patients. When tested in adults with ARDS, it was shown to be well tolerated and safe. Raghavendran K, Willson D, Notter RH (2011) Surfactant therapy for acute lung injury and acute respiratory distress syndrome. Laboratory investigations have begun to reveal the molecular basis for surfactant metabolism and the relationship of this complex process to alveolar stability and pulmonary function. However, respiratory morbidity, primarily bronchopulmonary dysplasia, remains unacceptably high. 2011 Jul;27(3):525-59. doi: 10.1016/j.ccc.2011.04.005. The most updated practice guidelines do recommend the use of endotracheal instillation as the preferred A number of conditions, such as pneumonia, trauma, or systemic sepsis arising from the gut, may result in the acute respiratory distress syndrome (ARDS). 2020 Oct 27;8(1):63. doi: 10.1186/s40635-020-00352-w. Inflammation. Role of inositol to improve surfactant functions and reduce IL-6 levels: A potential adjuvant strategy for SARS-CoV-2 pneumonia? Surfactant characteristics Surfactant composition and pool The chemical composition of pulmonary surfactant is known to be quite similar among several . Surfactant therapy is the medical administration of exogenous surfactant. -Exogenous surfactant + steroids added benefit -Without surfactant, steroid therapy is still extremely useful. Found insideA practical, comprehensive guide to the special needs of infants and neonates undergoing anesthesia. Surfactant protein D (SP-D) is a collectin protein synthesized by alveolar type II cells in the lungs. Ongoing clinical trials of surfactant therapy to treat COVID-19 patients. Three regional neonatal intensive care units. Exogenous surfactant therapy has been recognised as an approach to alleviating the surfactant-deficient state for 3 decades. The primary outcome was change in respiratory status following surfactant therapy, as reflected by oxygenation index (OI) and arterial/Alveolar oxygen ratio. Recently, some interesting clinical observations and several animal studies involving transgenic and gene knockout models have further demonstrated the essential role of the various surfactant components, specifically the surfactant proteins for normal lung function [7]. Time-dependent changes in pulmonary surfactant function and composition in acute respiratory distress syndrome due to pneumonia or aspiration. Download. Biophysical behavior of lung surfactant: implications for respiratory physiology and pathophysiology. Three trials were identified that met study criteria. This review of trials found that multiple doses, rather than a single dose, further improved babies' outcomes. These data indicate that improvements in oxygenation and lung volume in lavaged rats are dependent on the concentration of dSP-B(1-25) in the surfactant preparation and that the presence of SP-Cfc has a relative minor effect on these parameters. Randomized controlled trials comparing a policy of multiple doses of surfactant to a policy of single doses of surfactant extract in premature infants at risk for or having respiratory distress syndrome were considered for this review. Surfactant replacement has become routine for the prevention and treatment of infant RDS and other causes of neonatal lung injury. In addition, myo-inositol has been found able to decrease the levels of IL-6 in several experimental settings, due to an effect on the inositol-requiring enzyme 1 (IRE1)-X-box-binding protein 1 (XBP1) and on the signal transducer and activator of transcription 3 (STAT3) pathways. SP-B's biophysical functions can be partially mimicked by subfragments of the protein, including the C-terminus. Lauer S, Fischer LG, Stubbe HD, Van Aken H, Westphal M. Anaesthesist. Over the last decade, because of improvements in neonatal care and increased use of antenatal steroids and surfactant replacement therapy, mortality from respiratory distress syndrome has dropped substantially. The purpose of this study was to perform a systematic review and meta-analysis of exogenous surfactant administration to assess whether this therapy may be useful in adult patients with acute respiratory distress syndrome. Due to surfactant inactivation, multiple doses of surfactant may lead to improved outcome. Pediatr Res. In infants with established respiratory distress, a policy of multiple doses of animal derived surfactant extract resulted in greater improvements regarding oxygenation and ventilatory requirements, a decreased risk of pneumothorax and a trend toward improved survival. Exogenous surfactant therapy in thirty-eight hour lung graft preservation for transplantation. A few reports have demonstrated an improvement in lung function after intratracheal instillation of surfactant in animals and humans suffering from acute respiratory failure caused by pneumonia [1, 2]. Nine infants had meconium aspiration syndrome, five had congenital pneumonia and one had adult respiratory distress syndrome. Found insideThis book will focus on the pregnancy complications and birth outcomes, from the aspects of gestational age, environmental, genetic, epigenetic risk factors, and delivery room management. : 2 Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea. 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