Effects of exogenous surfactant supplementation and partial liquid ventilation on acute lung injury induced by wood smoke inhalation in newborn piglets

Jeng, Mei Jy; Kou, Yu Ru; Sheu, Ching Chung; Hwang, Betau

doi:10.1097/01.ccm.0000059312.90697.32

Cited by 22 publications

(25 citation statements)

References 46 publications

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“…Our investigation further demonstrates the effect of regional cooling, pulmonary mechanics, and lung architecture in these experimental animals as a result of various cooling strategies. Our histological fi ndings are consistent with other reports that have shown the protective effect of PFC on alveolar structures with different types of lung injury under normothermic conditions [7][8][9] . Pulmonary atelectasis in the ventilated and paralyzed animals of the EC group might have been enhanced with the cooling process; however, that condition was prevented by PFC liquid in the IC and EC = IC groups, especially in the dependent regions of lungs.…”

Section: Discussionsupporting

confidence: 82%

“…Perfl uorochemical (PFC) liquids used in ventilation have proven to be effective in supporting gas exchange and lung volume in animal and human studies [7][8][9][10][11][12] , but little is known about the ability of the thermal energy transmittance by PFC liquid ventilation. Because the alveolar surface area in a mammal's lung is about 100 times larger than its body surface area [13] , it is reasonable to speculate that there will be effi cient thermal energy transmittance across a huge contact area between the liquid, alveolar space, and the blood in the alveolar capillaries.…”

Section: Introductionmentioning

confidence: 99%

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Cold Perfluorochemical-Induced Hypothermia Protects Lung Integrity in Normal Rabbits

et al. 2005

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To test the hypothesis that intrapulmonary perfluorochemical (PFC) liquid may induce hypothermia, and to compare the effects of internal (IC), external (EC), and combined cooling techniques (EC + IC), 14 juvenile rabbits were randomized to EC by a cold blanket (4°C, n = 5), IC by intrapulmonary cold PFC liquid lavage (4°C, n = 5), or combined IC with PFC and EC (n = 4). Arterial blood gas, blood pressure, and lung mechanics were monitored, and lung histology was examined by light microscopy. The results showed that cooling rates and the time needed to be cooled down to 30°C were significantly faster in EC and EC + IC than IC (p < 0.05). Blood gas analysis and cardiopulmonary function were within the normal range in all groups. Histological assessment revealed varied atelectasis in all lung regions in EC, whereas PFC-filled lungs (IC and EC + IC) demonstrated more homogenous expansion and no evidence of atelectasis. The results indicate that intrapulmonary PFC may be an effective technique to induce and/or augment hypothermia while supporting gas exchange, lung volume and pulmonary architecture.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Cold Perfluorochemical-Induced Hypothermia Protects Lung Integrity in Normal Rabbits

et al. 2005

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“…LIN et al [17] reported that wood smoke inhalation initially (within 5 min) causes airway injury, and subsequently (within 2 h) produces both airway and parenchymal injury. A similar model has been investigated by JENG et al [18], who studied the effects of exogenous surfactant supplementation and partial liquid ventilation in treating acute lung injury. Furthermore, MONTANO et al [19] analysed the effects of wood smoke exposure on matrix metalloproteinase (MMP) activity and expression in macrophages and bronchoalveolar lavage fluid obtained from patients exposed to wood or tobacco smoke, and from control subjects.…”

Section: Discussionmentioning

confidence: 98%

Wood smoke exposure and risk of chronic obstructive pulmonary disease

Orozco-Levi¹

2006

Eur Respir J

272

142

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It was hypothesised that wood smoke exposure could be a risk factor for chronic obstructive pulmonary disease (COPD) in Spain. The present study was designed as a casecontrol study of 120 females requiring hospitalisation during 2001-2003 at Hospital del Mar (Barcelona, Spain).Cases were recruited from hospital records as females who had been admitted for an exacerbation of COPD. Controls were obtained from pulmonary function test laboratory consultations prior to a surgical intervention. All patients answered a standardised questionnaire.Exposure to wood or charcoal smoke was strongly associated with COPD after adjusting for age and smoking. The association between length of exposure and COPD suggested a doseresponse pattern. Intensity of exposure in both summer and winter was also related to COPD. Wood or charcoal alone independently increased risk of COPD (odds ratio (OR) 1.8 and 1.5, respectively), but only the combination of both was statistically significant (OR 4.5).In conclusion, the present study shows a strong association between wood or charcoal smoke exposure and chronic obstructive pulmonary disease, supporting its existence not only in developing countries, but also in European countries, such as Spain. Further studies assessing whether this association also exists in other European societies are warranted.

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“…The histology was scored using a quantitative scoring system by an investigator blinded to the study group. Injury variables scored were alveolar and interstitial inflammation, alveolar and interstitial hemorrhage, atelectasis, and necrosis (41,42). The severity of injury was graded according to the following scales: no injury ϭ 0; injury to 25% of the field ϭ 1; injury to 50% of the field ϭ 2; injury to 75% of the field ϭ 3; and diffuse injury ϭ 4.…”

Section: Methodsmentioning

confidence: 99%

Effective Lavage Volume of Diluted Surfactant Improves the Outcome of Meconium Aspiration Syndrome in Newborn Piglets

2009

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Meconium aspiration syndrome (MAS) is one of the top causes of severe respiratory failure in neonates. This study was designed to investigate the effective volume of therapeutic bronchoalveolar lavage (BAL) with diluted surfactant in the treatment of MAS in newborn piglets. Human meconium was instilled in 24 piglets to induce MAS, and the piglets were randomly divided into four groups: 1) control, no lavage; 2) lavage-10, BAL with diluted surfactant (5 mg/mL, Survanta) 10 mL/kg in two aliquots; 3) lavage-20, 20 mL/kg in two aliquots; 4) lavage-30, 30 mL/kg in two aliquots. Cardiopulmonary parameters were monitored, and the lung tissue was histologically examined after experiments. The changes in oxygenation and lung compliance of lavage-20 and lavage-30 groups were significantly better than control and lavage-10 groups (p Ͻ 0.05), but there was no significant difference between lavage-20 and lavage-30 groups. The lung injury scores were significantly lower in the dependent site of lavage-20 and lavage-30 groups than the other two groups. In conclusion, using 20 mL/kg diluted surfactant in two aliquots to perform therapeutic BAL was as effective as 30 mL/kg in improving the pathophysiological outcomes in MAS and may warrant consideration clinically in treating MAS. Despite improvement in immediate resuscitation at birth and the use of assisted ventilation, respiratory distress caused by aspirated meconium is difficult to manage. Even with innovative respiratory care, some neonates with severe MAS may become candidates for extracorporeal membrane oxygenation and high rates of mortality may occur (1-3).The mechanisms in pathogenesis of MAS typically includes local obstruction of the airway by meconium debris, with associated impairment of gas diffusion, patchy atelectasis, pulmonary vascular hypertension, pulmonary inflammation, chemical pneumonitis, and surfactant inactivity (4 -10). Bolus surfactant administration has been tested for the treatment of MAS previously, but no significant reduction in mortality and other morbidities was obtained (11)(12)(13)(14).Effective meconium removal without inactivating or washing out surfactant is a potential additional treatment for treating MAS. Theoretically, the concept of therapeutic bronchoalveolar lavage (BAL) involves dilution and removal of the meconium from the airspaces. Intervention to treat progressive MAS using BAL with saline has not proved to be clinically useful (15,16) and may even be detrimental as the volume of saline can further impede gas exchange and worsen lung mechanics. Some authors have tried to use bolus surfactant given after saline lavage (15,(17)(18)(19)(20), but the surfactant distribution was not uniformly obtained in the same manner as when using surfactant lavage (21,22).Recently, technique of therapeutic BAL with diluted exogenous surfactant has been tried and shown some promising benefits in improving pathophysiological responses, increasing meconium removal amount, lowering ventilation duration, and decreasing the severity of ill...

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Effects of exogenous surfactant supplementation and partial liquid ventilation on acute lung injury induced by wood smoke inhalation in newborn piglets

Cited by 22 publications

References 46 publications

Cold Perfluorochemical-Induced Hypothermia Protects Lung Integrity in Normal Rabbits

Cold Perfluorochemical-Induced Hypothermia Protects Lung Integrity in Normal Rabbits

Wood smoke exposure and risk of chronic obstructive pulmonary disease

Effective Lavage Volume of Diluted Surfactant Improves the Outcome of Meconium Aspiration Syndrome in Newborn Piglets

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