Reduction in lung injury after combined surfactant and high-frequency ventilation.

Jackson, J. Craig; Truog, William E.; Standaert, T. A.; Murphy, James P.; Juul, Sandra E.; Y, E; Hildebrandt, J.; Hodson, W. Alan

doi:10.1164/ajrccm.150.2.8049842

Cited by 89 publications

(50 citation statements)

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“…Similarly, Hilgendorff et al [21] in an animal model showed that open-lung ventilation alone did better than surfactant and conventional ventilation. Human data confirmed the efficacy of HFOV recruitment maneuver in improving both functional lung capacity [22,23] and inflammatory lung profiles [24,25]. Furthermore, in two recent randomized controlled trials comparing HFO with CMV [7,8], ELR during HFOV allowed the number of repeated surfactant doses in VLBW infants with RDS to be reduced compared to infants assigned to conventional ventilation who were not submitted to a lung recruitment attempt.…”

Section: Discussionmentioning

confidence: 77%

Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants

et al. 2010

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Purpose: Early lung recruitment (ELR) during high-frequency oscillatory ventilation (HFOV) in combination with prophylactic surfactant use has been reported to reduce mortality, improve respiratory outcomes, and reduce the need for repeated surfactant dosing, suggesting that surfactant might be used more selectively in very low birth weight (VLBW) infants on HFOV than generally recommended. We report our first experience from such a selective early rescue use of surfactant in VLBW infants on HFOV. Methods: After a deliberate ELR maneuver and ''optimal'' continuous distending pressure (CDP) finding during HFOV, used as primary ventilation mode for VLBW infants with respiratory distress syndrome (RDS), surfactant was only given when an unsatisfactory oxygenation response to lung recruitment (as defined by CDP 9 FiO 2 [ 5) was observed. Results: Out of 144 VLBW infants on HFOV, 84 (58.3%) received surfactant and 60 (41.7%) did not. Duration of required oxygen supplementation (37.4 ± 44.9 vs.46.2 ± 35.4 days; P = 0.031) and respiratory support (i.e., n-CPAP and/or mechanical ventilation; 22.3 ± 19.3 vs. 38.2 ± 24.3 days; P = 0.001) was shorter for infants who did not receive surfactant than for those who did. The incidence and severity of bronchopulmonary dysplasia was similar in both groups, and there was no difference in survival rates between groups. Subgroup analysis for infants of less than 28 weeks of gestation revealed similar results. Conclusions: First intention HFOV combined with an early attempt at lung volume optimization might allow surfactants to be used more selectively (in relation to disease severity) in VLBW infants presenting with RDS at birth without negatively influencing the outcome.

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Section: Discussionmentioning

confidence: 77%

Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants

et al. 2010

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“…It should be stressed that all these apparently disappointing reports refer to acute respiratory distress syndrome, or meconium injury. Preventive strategies of high frequency oscillatory ventilation [42], HFOV combined with exogenous surfactant [43] in premature baboons, and tidal liquid ventilation in preterm lambs [44] clearly reduce histologic lung injury. Recently, Kinsella et al [45] compared HFOV, PLV, and CMV after surfactant therapy in extremely premature lambs.…”

Section: Discussionmentioning

confidence: 99%

High-Frequency Oscillatory Ventilation, Partial Liquid Ventilation, or Conventional Mechanical Ventilation in NewbornPiglets with Saline Lavage-Induced Acute Lung Injury

Degraeuwe

Thunnissen²,

Vos³

et al. 1998

Neonatology

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It has been reported that, in diseased lungs, either partial liquid ventilation (PLV) or high-frequency oscillatory ventilation (HFOV) can improve oxygenation better and with less lung injury than conventional mechanical ventilation (CMV). This study was intended as a preclinical comparison between the effects of HFOV, PLV and CMV on gas exchange, lung mechanics and histology. Fifteen anesthetized newborn piglets, with respiratory insufficiency due to repeated saline lung lavage, were allocated to either a PLV, HFOV or CMV (n = 5 each) strategy, and treated for 4 h. Within 30 min of commencing therapy, PLV, HFOV, and CMV improved arterial Po₂ (Pa,o₂), alveoloarterial oxygen gradient (P(A-a),o₂), oxygenation index (OI), venous admixture (va), and arterial Pco₂ (Pa,co₂). After 4 h, oxygenation parameters (Pa,o₂, P(A-a),o₂, OI and venous admixture) were significantly better in the HFOV group than in the PLV group; the CMV group showed a higher Pa,o₂ and lower OI than the PLV group. Gas exchange at the end of the experiment was not different from baseline in the HFOV and CMV groups. Lung histology and morphometry were performed after perfusion-fixation at endotracheal deflation pressure corresponding to mean airway pressure at the end of the experiment. Lung injury score and mean linear intercept were not different between the three treatment groups. We conclude that in this model, gas exchange improved significantly in all three ventilation strategies. Indices of oxygenation improved less during PLV. The saline lavage-induced acute lung injury model used as in this study, is less stable than previously thought. The final lung injury is not influenced by the ventilation strategy. We speculate that the impaired gas exchange during PLV is an expression of diffusion limitation and ventilation-perfusion mismatch in a recovering lung.

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“…The delay between birth and surfactant-HFOV use, which may blunt the benefits of HFOV [5] is often a major difference between the procedures used in animal experiments and clinical trials. Starting HFOV at birth appears to be preferable in order to obtain any possible benefits of the technique.…”

Section: Discussionmentioning

confidence: 99%

“…A pulmonary benefit of using HFOV with a high-volume strategy (HVS), compared with CV, has been shown without the use of exogenous surfactant in early studies [3] and more recently, in combination with exogenous surfactant [4,5]. The benefits of HFOV include a decrease of inflammatory mediators, which are early predictors of the development of CLD [6,7].…”

Section: Animal Experimentsmentioning

confidence: 99%

High-Frequency Oscillatory Ventilation in the Management of Respiratory Distress Syndrome

Moriette

Brunhes²,

Jarreau³

2000

Neonatology

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Early use of high-frequency oscillatory ventilation with a high volume strategy (HFOV-HVS) has been proposed to decrease the incidence of chronic lung disease following respiratory distress syndrome (RDS) in extremely immature infants. Despite encouraging results of animal experiments, clinical trials have provided discordant results. Our own multicenter trial showed that using HFOV-HVS, compared with conventional ventilation, decreased exogenous surfactant requirements, but did not modify pulmonary outcome, and increased the risk of severe intraventricular hemorrhage. This prompted us to change our management of RDS, by switching from elective use of HFOV to an ‘early rescue’ approach.

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Reduction in lung injury after combined surfactant and high-frequency ventilation.

Cited by 89 publications

References 0 publications

Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants

Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants

High-Frequency Oscillatory Ventilation, Partial Liquid Ventilation, or Conventional Mechanical Ventilation in NewbornPiglets with Saline Lavage-Induced Acute Lung Injury

High-Frequency Oscillatory Ventilation in the Management of Respiratory Distress Syndrome

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