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Surfactant Treatment (surfactant + treatment)
Selected AbstractsSurfactant treatment in the ICU: alternative interpretations of existing evidencePEDIATRIC ANESTHESIA, Issue 8 2006WOLFGANG STROHMAIER No abstract is available for this article. [source] Natural surfactant combined with beclomethasone decreases oxidative lung injury in the preterm lambPEDIATRIC PULMONOLOGY, Issue 12 2009Carlo Dani MD Abstract We performed a randomized study in preterm lambs to assess the hypothesis that the treatment with natural surfactant combined with beclomethasone might decrease pulmonary oxidative stress in an animal model of respiratory distress syndrome (RDS). Animals received 200,mg/kg of porcine natural surfactant or 200,mg/kg of natural surfactant combined with 400 or 800,µg/kg of beclomethasone. Lung tissue oxidation was studied by measuring total hydroperoxide (TH), advanced oxidation protein products (AOPP), and non-protein bound iron (NPBI) in bronchial aspirate samples. In addition, lung mechanics was evaluated. TH was lower in the groups treated with surfactant plus 400 or 800,µg/kg of beclomethasone than in the surfactant group; AOPP was lower in the group treated with surfactant plus 800,µg/kg of beclomethasone than in the other groups; NPBI was similar in all groups. Surfactant treatment was followed by a sustained improvement of tidal volume (TV) and airway resistance, while dynamic compliance did not vary. However, the mean airway pressure needed to obtain similar values of TV was lower in the group treated with surfactant plus 800,µg/kg of beclomethasone than in other groups. We concluded that natural surfactant combined with beclomethasone at 800,µg/kg is effective in reducing the oxidative lung stress and improving the respiratory function in an animal model of RDS. Pediatr Pulmonol. 2009; 44:1159,1167. © 2009 Wiley-Liss, Inc. [source] Lung function tests in neonates and infants with chronic lung disease: Lung and chest-wall mechanicsPEDIATRIC PULMONOLOGY, Issue 4 2006Monika Gappa MD This is the fifth paper in a review series that summarizes available data and critically discusses the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy (CLDI). This review focuses on respiratory mechanics, including chest-wall and tissue mechanics, obtained in the intensive care setting and in infants during unassisted breathing. Following orientation of the reader to the subject area, we focused comments on areas of enquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically with respect to relevant methods, equipment and study design, limitations and strengths of different techniques, and availability and appropriateness of reference data. Recommendations to guide future investigations in this field are provided. Numerous different methods have been used to assess respiratory mechanics with the aims of describing pulmonary status in preterm infants and assessing the effect of therapeutic interventions such as surfactant treatment, antenatal or postnatal steroids, or bronchodilator treatment. Interpretation of many of these studies is limited because lung volume was not measured simultaneously. In addition, populations are not comparable, and the number of infants studied has generally been small. Nevertheless, results appear to support the pathophysiological concept that immaturity of the lung leads to impaired lung function, which may improve with growth and development, irrespective of the diagnosis of chronic lung disease. To fully understand the impact of immaturity on the developing lung, it is unlikely that a single parameter such as respiratory compliance or resistance will accurately describe underlying changes. Assessment of respiratory mechanics will have to be supplemented by assessment of lung volume and airway function. New methods such as the low-frequency forced oscillation technique, which differentiate the tissue and airway components of respiratory mechanics, are likely to require further development before they can be of clinical significance. Pediatr Pulmonol. © 2006 Wiley-Liss, Inc. [source] Changes in arterial oxygen tension when weaning neonates from inhaled nitric oxide,,PEDIATRIC PULMONOLOGY, Issue 1 2001Gregory M. Sokol MD Abstract We set out to evaluate changes in arterial oxygen tension (PaO2) when weaning neonates from inhaled nitric oxide (INO). We reviewed the records of 505 prospectively collected INO weaning attempts on 84 neonates with hypoxic respiratory failure. PaO2 values before and 30 min after weaning attempts were recorded. Relationships between change in PaO2 and decreases in INO concentrations were investigated using regression analysis and ANOVA. PaO2 decreased (,18.7,±,1.8 torr; P,<,0.001); when weaning INO. A stepwise decline in PaO2 was observed weaning INO from 40 ppm. The greatest decline occurred when INO was discontinued (,42.1,±,4.1 torr). Forward stepwise multiple regression using variables with significant relationships to the decline in PaO2 identified the specific dose reduction 7(P,<,0.001), the prewean PaO2 (P,<,0.001), and surfactant therapy (P,=,0.018) as the variables best describing the change in PaO2(P,=,0.004, r,=,0.51). In conclusion, a graded decline in PaO2 occurs when reducing INO. INO should be weaned to less than 1 ppm before discontinuing its use. Prior surfactant treatment appears to enhance the oxygenation reserve when weaning INO. Pediatr Pulmonol. 2001; 32:14,19. © 2001 Wiley-Liss,Inc. [source] Contribution of pulmonary surfactant with inhaled nitric oxide for treatment of pulmonary hypertensionPEDIATRICS INTERNATIONAL, Issue 5 2006SATOSHI KUSUDA Abstract Background: Combined therapy of inhaled nitric oxide (iNO) with pulmonary surfactant replacement was reported to improve oxygenation in patients or animal models of persistent pulmonary hypertension of the newborn with pulmonary surfactant deficiency lung. To evaluate the potential of iNO for the treatment of persistent pulmonary hypertension of the newborn, pulmonary arterial pressure (PAP) was measured during iNO before and after pulmonary surfactant replacement in an animal model of pulmonary hypertension with surfactant deficiency. Methods: Seven newborn piglets were injected with L-nitro-arginine-methylester to produce an animal model of pulmonary hypertension. After PAP increased, iNO (30 p.p.m.) was introduced. Then iNO was stopped, and animals were subjected to lung lavage with saline. After recording the effect of iNO, all animals then received exogenous pulmonary surfactant installation. After surfactant treatment, iNO was again introduced. Results: Pulmonary arterial pressure and systemic arterial pressure were increased significantly by >30% after infusion of L-nitro-arginine-methylester. During iNO only PAP was reduced significantly. Respiratory system compliance decreased significantly after lung lavage, and increased significantly after pulmonary surfactant replacement with concomitant increase of PaO2. In contrast, significant reduction of PAP with iNO before and after pulmonary surfactant replacement were also observed. The reduction ratios of PAP under each condition were 75.2 ± 7.4%, 81.3 ± 3.1%, and 79.1 ± 5.3%, respectively (not significant among conditions). Conclusion: These results suggest that iNO is still a potent pulmonary arterial vasodilator even under pulmonary surfactant deficiency in an animal model of pulmonary hypertension. [source] Nitric oxide inhalation therapy in very low-birthweight infants with hypoplastic lung due to oligohydramniosPEDIATRICS INTERNATIONAL, Issue 1 2004Naoki Uga AbstractBackground: Although nitric oxide inhalation (iNO) therapy improves arterial oxygenation and reduces the rate of extracorporeal membrane oxygenation in term neonates, the efficacy of this therapy in premature infants is controversial. The objective of the present study was to determine whether iNO therapy improves the survival of very low-birthweight infants with pulmonary hypoplasia due to prolonged rupture of membrane. Methods: A retrospective comparative study of very low-birthweight infants with pulmonary hypoplasia due to oligohydramnios who had or had not been treated with iNO therapy, was performed (iNO-treated group, eight infants; control group, 10 infants). A neonate was considered to have pulmonary hypoplasia due to oligohydramnios if the following conditions were satisfied: (i) artificial surfactant treatment did not improve the respiratory distress; (ii) prolonged rupture of membrane (PROM) continued for more than 5 days with oligohydramnios; and (iii) sufficient arterial oxygenation did not occur even after giving 100% oxygen, and more than 8 cm H2O of mean airway pressure was needed to maintain arterial oxygenation. Results: Nitric oxide inhalation improved arterial oxygenation rapidly and consistently in all eight infants with pulmonary hypoplasia. All eight iNO-treated infants survived longer than 28 days, while five of the 10 control infants died within 24 h of birth (P < 0.05). Before starting iNO, seven of the eight treated infants had shown persistent pulmonary hypertension, which was confirmed by echocardiography. No iNO-treated infant had IVH greater than grade 1, while one control infant had grade 2 IVH. All six long-term survivors in the iNO-treated group are developing normally, while only two of the control infants are developing normally as of February 2002. Conclusions: The majority of the infants with pulmonary hypoplasia due to oligohydramnios had persistent pulmonary hypertension. iNO improved the arterial oxygenation and significantly improved the survival rate. A controlled study to determine whether iNO therapy improves the survival rate of preterm infants with pulmonary hypoplasia due to oligohydramnios is necessary. [source] Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasiaACTA PAEDIATRICA, Issue 9 2009Henrik Verder Abstract The Scandinavian approach is an effective combined treatment for respiratory distress syndrome (RDS) and prevention of bronchopulmonary dysplasia (BPD). It is composed of many individual parts. Of significant importance is the early treatment with nasal continuous positive airway pressure (nCPAP) and surfactant treatment. The approach may be supplemented with caffeine citrate and non-invasive positive pressure ventilation for apnoea. The low incidence of BPD seen as a consequence of the treatment strategy is mainly due to a reduced need for mechanical ventilation (MV). Conclusion:, Early-postnatal treatment with nCPAP and surfactant decreases the severity and mortality of RDS and BPD. This is mainly due to a diminished use of MV in the first days of life. [source] Neurodevelopmental outcome and pulmonary morbidity two years after early versus late surfactant treatment: does it really differ?ACTA PAEDIATRICA, Issue 4 2009R Hentschel Abstract Aim: To investigate whether neurodevelopmental outcome or pulmonary morbidity at age two years might be different after early versus late surfactant treatment in intubated preterm infants with severe respiratory distress syndrome (RDS). Methods: In 185 ex-preterm infants of 27,32 completed weeks of gestation, who were enrolled in a controlled trial of early versus late surfactant treatment (31 ± 19 min vs. 202 ± 80 min, respectively), a standardized follow up of medical history, pulmonary morbidity and neurodevelopmental outcome using the Griffiths scales were carried out. Results: Neurobehavioural and motor development was comparable in both groups, as was medical history and actual morbidity. However, in the early treatment group a delay in the subscale ,personal social' of the Griffiths test and in one ,milestone' of motor development (rolling over from supine to prone) was noticed, and the rate of increased muscular tone was significantly higher. Conclusion: In terms of long-term morbidity or neurological development there is no obvious advantage of an immediate surfactant administration after intubation in preterm infants with RDS. This is in line with our results published earlier on morbidity at discharge, so improvement of gas exchange after intubation can first be awaited before surfactant is indicated. [source] Kinetics of the M-Intermediate in the Photocycle of Bacteriorhodopsin upon Chemical Modification with SurfactantsPHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 2 2010Li-Kang Chu The spectroscopic and kinetic studies of the interaction between bacteriorhodopsin in the M-intermediate and several surfactants (cetyl trimethyl ammonium bromide, dodecyl trimethyl ammonium bromide, diethylene glycol mono- n -hexyl ether, ethylene glycol mono- n -hexyl ether, sodium 1-decanesulfonate and sodium 1-heptanesulfonate) have been investigated using steady-state UV,VIS spectrometry and time-resolved absorption techniques. The steady-state spectral results show that bR retains its trimeric state. Time-resolved observations indicate that the rate of deprotonation of the protonated Schiff base increases in the presence of the cationic surfactants, whereas insignificant changes are observed in the neutral or anionic surfactants. The rate of the reprotonation of the Schiff base in the transition M , N is accelerated in anionic and neutral surfactants, but is decelerated in the presence of the cationic surfactants. Surfactants with a longer hydrocarbon tail have a greater effect on the kinetics when compared with surfactants having shorter hydrocarbon tails. The opposite effect is observed when the hydrophilic head of the surfactants contains opposite charges. These distinct kinetics are discussed in terms of the difference in the modified surface hydrophilicity of the bR and the possible protein configurational changes upon surfactant treatments. [source] | ||||||||||