Beneficial effect of exogenous pulmonary surfactant in infants suffering acute respiratory distress syndrome after cardiac surgery / 中国小儿急救医学

Objective To explore whether using of exogenous pulmonary surfactant( PS) can im-prove recovery of infants suffering postoperative acute respiratory distress syndrome after cardiac surgery and whether kinetic analysis of pulmonary functional change can be helpful to indicate an appropriate dosing scheme. Methods Nineteen infants received an exogenous PS( Curosurf,100 mg/kg,treatment group) due to acute respiratory distress syndrome after cardiac surgery for congenital heart defects. They were compared with 24 patients without its administration despite the same postoperative complication( control group) . Oxy-genation index( OI) and ventilation index( VI) were calculated and fitted with a monoexponential function be-fore and after its use. Other outcomes including chest radiography,duration of mechanical ventilation,inten-sive care unit and hospitalization were also analyzed. Results All infants who received PS survived,whereas three infants in the control group died. The duration of mechanical ventilation and hospitalization were signifi-cantly shorter after PS administration[(21. 3 ± 9. 2) d vs. (31. 1 ± 13. 4) d,t=6. 520,P=0. 004;(30. 2 ± 13. 2)d vs. (41. 3 ± 16. 5)d,t=2. 185,P=0. 03]. The infants received either one (13 cases,subgroup A) or two doses (6 cases,subgroup B) before successful weaning from the ventilator. After the first dose was ad-ministered,the maximal rates of OI and VI change were significantly higher of infants in the subgroup A[OI:(2. 9 ±1. 7) vs. (1. 0 ± 0. 8),t =3. 012,P =0. 02;VI:(16. 6 ± 9. 6) vs. (5. 8 ± 5. 6),t =2. 980,P =0. 02]. Twelve hours after the first dose,both parameters in the subgroup B deteriorated and a second dose was administered 24 h later. Conclusion Exogenous PS is an efficient medication for infants suffering acute respiratory distress syndrome after cardiac surgery. Kinetics analysis of functional change after initial surfac-tant use may be referred for early determination of an optimal dosing scheme.

Research progress of exogenous pulmonary surfactant in the treatment of neonatal respiratory distress syndrome / 临床儿科杂志

Exogenous pulmonary surfactant (PS) has been widely applied in the treatment of neonatal respiratory distress syndrome (NRDS), and its curative effect was confirmed. However, there is still controversy about the dosage, timing of administration and the routes of administration. This article reviews the progress of the application of PS in NRDS in recent 3 years, and provides a basis for strategies of clinical diagnosis and treatment.

Effects of Two Different Surfactants on RBC Membrane and Type II Alveolar Epithelial Cell in Vitro

PURPOSE: Respiratory distress syndrome(RDS) is a major cause of death in premature babies. For the treatment of RDS, various artificial pulmonary surfactants have been used. The incidence of pulmonary hemorrhage is increased in association with surfactant therapy in extremely low birth weight infants. But the pathogenesis of this increased incidence is not clear. So we conducted this study to prove whether exposure of RBC or type II alveolar epithelial cell membrane to Surfacten(R) or Exosurf(R) or additive component of Exosurf(R) may lead to increased membrane permeability. METHODS: Washed packed RBC(30microliter) with various concentrations of Surfacten(R), Exosurf(R), hexadecanol and tyroxapol(concentration similar to their content in each Exosurf(R)), were incubated for 2, 24 and 48 hour at 37degrees C. Hemolysis was measured by spectrophotometry. Type II alveolar epithelial cell(HTB-181)(106cell/mL) with 2, 4, 6 and 8mg of Surfacten(R) or Exosurf(R) were incubated for 24 hour at 37degrees C. Lactate dehydrogenase(LDH) release was measured as an indicator of cytotoxicity. RESULTS: RBC hemolysis was increased in a time and dose-dependent manner with both artificial surfactants and additive components of Exosurf(R). This trend, especially, was typically seen in the sample which was incubated for 24 hours, where more hemolysis was seen with Exosurf(R) and tyroxapol than Surfacten(R) and hexadecanol with the above concentration of 2.5mg/2mL(P<0.05). LDH released from type II alveolar epithelial cell with Exosurf(R) was greater than with Surfacten(R), especially at the concentration of 6mg/106cell(P<0.05). CONCLUSION: Artificial surfactant may be associated with in vitro cytotoxicity on RBC membrane and aveolar epithelial cell, and this property was more prominent with Exosurf(R) and the additive components of Exosurf(R), especially with tyroxapol.

Effects of Two Different Surfactants on RBC Membrane and Type II Alveolar Epithelial Cell in Vitro

PURPOSE: Respiratory distress syndrome(RDS) is a major cause of death in premature babies. For the treatment of RDS, various artificial pulmonary surfactants have been used. The incidence of pulmonary hemorrhage is increased in association with surfactant therapy in extremely low birth weight infants. But the pathogenesis of this increased incidence is not clear. So we conducted this study to prove whether exposure of RBC or type II alveolar epithelial cell membrane to Surfacten(R) or Exosurf(R) or additive component of Exosurf(R) may lead to increased membrane permeability. METHODS: Washed packed RBC(30microliter) with various concentrations of Surfacten(R), Exosurf(R), hexadecanol and tyroxapol(concentration similar to their content in each Exosurf(R)), were incubated for 2, 24 and 48 hour at 37degrees C. Hemolysis was measured by spectrophotometry. Type II alveolar epithelial cell(HTB-181)(106cell/mL) with 2, 4, 6 and 8mg of Surfacten(R) or Exosurf(R) were incubated for 24 hour at 37degrees C. Lactate dehydrogenase(LDH) release was measured as an indicator of cytotoxicity. RESULTS: RBC hemolysis was increased in a time and dose-dependent manner with both artificial surfactants and additive components of Exosurf(R). This trend, especially, was typically seen in the sample which was incubated for 24 hours, where more hemolysis was seen with Exosurf(R) and tyroxapol than Surfacten(R) and hexadecanol with the above concentration of 2.5mg/2mL(P<0.05). LDH released from type II alveolar epithelial cell with Exosurf(R) was greater than with Surfacten(R), especially at the concentration of 6mg/106cell(P<0.05). CONCLUSION: Artificial surfactant may be associated with in vitro cytotoxicity on RBC membrane and aveolar epithelial cell, and this property was more prominent with Exosurf(R) and the additive components of Exosurf(R), especially with tyroxapol.

Exogenous pulmonary surfactant replacement therapy in a neonate with pulmonary hypoplasia accompanying congenital diaphragmatic hernia: a case report

Pulmonary hypoplasia(PH) commonly occurs in association with oligohydramnios and other congenital anomalies, especially congenital diaphragmatic hernia (CDH). Pulmonary hypoplasia is an important factor, as persistent pulmonary hypertension, in the prognosis of CDH. In some reports, there is a decrement of pulmonary surfactant in PH accompanying CDH. Recently, there are some reports that exogenous pulmonary surfactant therapy is effective in experimental animal model and neonatal respiratory distress with PH. We report a case of a 5 day-old male neonate, who had shown dyspnea and diagnosed as left pulmonary hypoplasia accompanying CDH. The CDH was surgically treated and the ipsilateral PH, with intratracheal administration of exogenous pulmonary surfactant postoperatively. After exogenous pulmonary surfactant application, the left lung volume was increased on chest roentgenogram and lung perfusion scan findings, and there was an improvement in oxygenation and clinical manifestations. We suggest that postoperative exogenous pulmonary surfactant replacement therapy is effective in the case of PH and further trials are needed to clarify the optimal dose and timing of supplementation of surfactant for treatment of infants with PH accompanying CDH.