Functional residual capacity and compliance of the respiratory system after surfactant treatment in premature infants with severe respiratory distress syndrome

Dinger, Jürgen; Töpfer, Andreas; Schaller, Peter; Schwarze, Roland

doi:10.1007/s00431-002-0989-6

Cited by 28 publications

(23 citation statements)

References 34 publications

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“…Although all infants were successfully extubated and the neuromuscular blockade was removed, the FRC values were slightly lower than that reported by VON UNGERN-STERNBERG et al [8] in intubated infants prior to anaesthetic procedures (21.3¡4.7 mL?kg -1 ). However, the infants in the present study were younger and lighter than those in the study by VON UNGERN-STERNBERG et al [8], and the present FRC values are consistent with those for ventilated pre-term infants [21,22] and nonventilated full-term control infants (18.4 mL?kg -1 ) [23].…”

Section: Neonatal Critical Care H Proquitté Et Alsupporting

confidence: 80%

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Proquitté¹,

Freiberger²,

Yılmaz³

et al. 2009

European Respiratory Journal

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In newborn infants, thoraco-abdominal surgery is a serious intervention with respect to gas exchange and lung mechanics. This prospective clinical study compared surgery-induced changes in functional residual capacity (FRC) and ventilation inhomogeneity (VI) indices with changes in conventional monitoring parameters.Of 29 ventilated newborns (mean weight 2,770¡864 g at surgery), 13, nine and seven underwent thoracic, abdominal or congenital diaphragmatic hernia (CDH) surgery, respectively. The multiple breath washout (MBWO) technique using heptafluoropropane as tracer gas (Babylog1 8000; Dräger, Lübeck, Germany) was performed ,6 h before surgery, 22-24 h after surgery and ,6 h before extubation. Gas exchange, respiratory mechanics, FRC and VI index data were recorded.Thoraco-abdominal surgery resulted in changes to FRC and VI indices in a procedure-specific manner; however, these changes were not reflected in conventional mechanical or ventilatory monitoring parameters. FRC decreased in non-CDH infants, while FRC increased and VI indices decreased in CDH infants. Despite improvements, the differences in FRC and VI between CDH and non-CDH infants indicated persistent impaired lung function in CHD infants.MBWO can be advantageously used to measure the effect of surgery on the lung. While FRC and VI indices changed following surgery, conventional monitoring parameters did not.KEYWORDS: Congenital diaphragmatic hernia, lung volume, mechanical ventilation, multiple breath washout, newborn infant, thoraco-abdominal surgery S urvival in newborn infants following corrective surgery for serious cardiac [1,2] or abdominal wall defects [3] or for congenital diaphragmatic hernia (CDH) [4] has improved over the last decade. Nevertheless, opening the thoracic cavity and/or abdominal wall remains a significant intervention with respect to temporary alterations in gas exchange and lung volume.In addition to ventilator monitoring, blood gas analyses and repeated radiographs are usually performed in ventilated infants to monitor clinical development. Meanwhile, commercial equipment is available to assess lung aeration by measuring functional residual capacity (FRC) and ventilation inhomogeneity (VI) indices [5][6][7]. This noninvasive method is based on the multiple breath washout (MBWO) measurement technique using a tracer gas [8]. However, the equipment used for simultaneously measuring airflow and molar mass of the breathing gas is generally bulky and cumbersome for routine applications in intubated newborns or premature infants, and requires significant floor space [9]. We have recently validated a prototype of an extended neonatal ventilator for MBWO analysis in small ventilated piglets [10]. This apparatus uses a miniaturised lightweight gas sensor and heptafluoropropane (HFP) as the tracer gas.We hypothesised that this technique can be advantageously used in a clinical setting to measure the effect of surgery on the lung. The aim of the present prospective clinical study was the use of the HPF-MBWO technique to i...

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Section: Neonatal Critical Care H Proquitté Et Alsupporting

confidence: 80%

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Proquitté¹,

Freiberger²,

Yılmaz³

et al. 2009

European Respiratory Journal

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“…17 The functional residual capacity of preterm infants with RDS is significantly decreased and the reported values can vary from 6 to 10 ml kg À1 . 18,19 Future studies should address this potential risk factor. It is well known that smaller ETT have higher resistance, 20 which can contribute to decreased or slower clearance of surfactant and subsequent ETT block.…”

Section: Discussionmentioning

confidence: 99%

Severe airway obstruction during surfactant administration using a standardized protocol: a prospective, observational study

Tarawneh

Kaczmarek

et al. 2011

J Perinatol

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Objective: The objective of this study was to evaluate the occurrence of adverse effects during surfactant delivery, using a standardized protocol for administration and management of complications.Study Design: The protocol was developed, implemented and used for 6 months. Vital signs and ventilatory parameters were prospectively recorded during the procedure. Infants were classified into three groups, based on the occurrence and severity of complications: no, minor or major.Result: A total of 39 infants received surfactant and 19 presented some complication: 11 minor and 8 major. Six of the major complications were episodes of severe airway obstruction (SAO) and five occurred in extreme low birth weight (ELBW) infants that had more severe lung disease before surfactant delivery. Two cases of persistent pulmonary hypertension occurred in infants with birth weight>1000 g. Conclusion:This study identified a high rate of SAO and provides data to support changes in the protocol, which should include faster and more robust increases in positive inspiratory pressures in ELBW infants presenting with SAO.

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“…However, multiple in vivo and in vitro studies have shown a negative effect of NO on surfactant activity as well as surfactant protein gene expression (26,58). In children with elevated pulmonary vascular resistance, any decrease in pulmonary compliance due to low surfactant activity can contribute to significant morbidity (13,31). Although the relationship between NO and surfactant has been studied, the model systems used previously included primary cultures that immediately begin to undergo dedifferentiation, whole animals, and alveolar epithelial cell lines that do not express the entire type II cell phenotype.…”

mentioning

confidence: 99%

Nitric oxide decreases surfactant protein gene expression in primary cultures of type II pneumocytes

Lee

Gonzalez

Chapin

et al. 2005

American Journal of Physiology-Lung Cellular and Molecular Phys

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Inhaled nitric oxide (NO) is a selective pulmonary vasodilator effective in treating persistent pulmonary hypertension in newborns and in infants following congenital heart disease surgery. Recently, multiple in vivo and in vitro studies have shown a negative effect of NO on surfactant activity as well as surfactant protein gene expression. Although the relationship between NO and surfactant has been studied previously, the data has been hard to interpret due to the model systems used. The objective of the current study was to characterize the effect of NO on surfactant protein gene expression in primary rat type II pneumocytes cultured on a substratum that promoted the maintenance of type II cell phenotype. Exposure to a NO donor, S-nitroso-N-acetylpenicillamine (SNAP), decreased surfactant protein (SP)-A, (SP)-B, and (SP)-C mRNA levels in type II pneumocytes in a time-and dose-dependent manner. The effect was mediated in part by an increase in endothelin-1 secretion and a decrease in the intracellular messenger, phosphorylated ERK1/2 mitogen-activated protein kinases (MAPK). Exposing type II pneumocytes to endothelin-1 receptor antagonists PD-156707 or bosentan before exposure to SNAP partially prevented the decrease in surfactant protein gene expression. The results showed that NO mediated the decrease in surfactant protein gene expression at least in part through an increase in endothelin-1 secretion and a decrease in phosphorylated ERK1/2 MAPKs. extracellular signal-regulated kinase 1/2; endothelin-1 INHALED NITRIC OXIDE (NO) is a selective pulmonary vasodilator effective in treating elevated pulmonary vascular resistance in newborns with persistent pulmonary hypertension (10, 50) and in children with pulmonary hypertension following congenital heart disease (CHD) surgery (8, 43). However, multiple in vivo and in vitro studies have shown a negative effect of NO on surfactant activity as well as surfactant protein gene expression (26,58). In children with elevated pulmonary vascular resistance, any decrease in pulmonary compliance due to low surfactant activity can contribute to significant morbidity (13,31). Although the relationship between NO and surfactant has been studied, the model systems used previously included primary cultures that immediately begin to undergo dedifferentiation, whole animals, and alveolar epithelial cell lines that do not express the entire type II cell phenotype.Previous experiments exploring the role of NO on surfactant synthesis, secretion, and/or metabolism have focused on the role of toxic intermediates of NO such as peroxynitrite (25-26, 28, 42, 61), methemoglobin (29 -30, 32), and nitrogen dioxide (NO 2 ) (45). In vitro, peroxynitrite has been shown to decrease surfactant surface activity through lipid peroxidation and nitration of tyrosine residues on surfactant protein (SP)-A and SP-B (25-26, 28, 42, 61). Haddad et al. (27) also have shown that, in freshly isolated adult rat type II cells, several NO donors decreased the rate of surfactant synthesis as measured by the ...

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Functional residual capacity and compliance of the respiratory system after surfactant treatment in premature infants with severe respiratory distress syndrome

Cited by 28 publications

References 34 publications

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Severe airway obstruction during surfactant administration using a standardized protocol: a prospective, observational study

Nitric oxide decreases surfactant protein gene expression in primary cultures of type II pneumocytes

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