Respiratory Failure Caused by Intratracheal Saline: Additive Effect of Xanthine Oxidase

Abstract

Administration of physiological saline or drugs together with saline into the airways is becoming common clinical practice. However, there are few studies on possible side effects. We have studied the effects of saline, saline plus xanthine oxidase, and saline plus xanthine oxidase plus superoxidase dismutase on lung-thorax compliance and on arterial blood gases in anesthetized, paralyzed guinea pigs, ventilated for 2.5 h. Saline bolus (2–3 ml isotonic saline/kg body weight) into the airways reduced the compliance within 20 min to a mean of 39% of the pretreatment levels, and necessitated an increase in the respirator pressure. Saline plus xanthine oxidase decreased the compliance to 16 % of the pretreatment levels. The xanthine oxidase-induced (but not saline-induced) decrease in lung compliance was relieved by superoxide dismutase. According to the present results xanthine oxidase induces a lung injury possibly by production of free oxygen radicals. Superoxide dismutase can be valuable in prevention of free oxygen radical-mediated lung damage. Saline alone can be harmful when applied to the airways. This should be considered in clinical trials and in clinical practice.

Prophylactic Effects of Recombinant Human Superoxide Dismutase in Neonatal Lung Injury Induced by the Intratracheal Instillation of Endotoxin in Piglets

“…Subscores for atelectasis were significantly lower in SOD-pretreated animals than in non-SOD-treated animals, but there were no differences between treatment groups: 3 (2-4) in group I, 2 (1-3) in group II, and 4 (3)(4)(5) in controls. Also, subscores for edema were significantly lower in SOD-pretreated animals than in non-SODtreated animals: 2 (2-4) in group I, 2 (1-2) in group II, and 4 (2-4) in controls.…”

“…Using neonatal piglets which closely resemble newborn human infants with regard to anatomic and physiologic aspects of the lungs, we recently established an animal model of acute lung injury similar to ARDS [3]. Previous studies, also including our study, showed the prophylactic effects of superoxide dismutase (SOD) pretreatment in alleviating acute lung injury caused by endotoxin in rats [4][5][6][7]. In the present study, we assessed the efficacy of endotracheal SOD administration for acute lung injury induced experimentally in neonatal piglets.…”

Chronic Lung Disease: The Role of Oxidative Stress

“…A series of experimental studies have shown that the free radical-generating system, hypoxanthine-xanthine oxidase, can damage the lung [7,[21][22][23]. These experimental data are supported by the results of Russell and Cooke [24] showing that premature infants who subsequently developed CLD had higher plasma hypoxanthine levels at birth than those who did not develop CLD.…”

Pulmonary Pathology in Surfactant-Treated Preterm Infants with Respiratory Distress Syndrome: An Autopsy Study

“…Normally, such fea tures should not be present 4 days after birth, while regenerative alveolar epithelium should be present, at least focaily. Similarly, in cases Biol Neonate 1996;70: [21][22][23][24][25][26][27][28]who survived 10, 12, and 13 days, epithelial necrosis and hyaline membrane formation were extensive, along with focal regenerative type II hyperplasia and mild septal fibrosis. In the case who survived 22 days, irregular atel ectasis and persistent alveolar cell necrosis were present; the latter should not be present after 15 days.…”

“…Many factors may be involved in the po tential mechanisms responsible for the in creased incidence of alveolar haemorrhage in surfactant-treated infants, including baro trauma, circulatory overload, capillary fragili ty, and free oxygen radical damage [20][21][22][23][24][25]. Free oxygen radicals play a key role in the pathogenesis of neonatal lung lesions.…”