Role of exogenous surfactant in acute lung injury

Lewis, James F.; Brackenbury, Angela

doi:10.1097/01.ccm.0000057911.19145.9f

Cited by 59 publications

(35 citation statements)

References 27 publications

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“…Major mechanisms of surfactant inactivation in ARDS include decreased synthesis and secretion of surfactant by the type II pneumocytes, decrease in surface active small aggregates of surfactant in the alveoli, and direct inhibition of surfactant function by substances like meconium, blood, serum proteins or proteinaceous edema fluid. 37 Exogenous surfactant therapy has been shown to be beneficial 70% of the time in patients with ARDS. 38 In a randomized, controlled trial using beractant in forty newborns with MAS, Findley et al 39 demonstrated a significant reduction in the need for extracorporeal membrane oxygenation (ECMO) therapy.…”

Section: Surfactant Therapy and Nasal Continuous Positive Airway Presmentioning

confidence: 99%

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Ramanathan

2006

J Perinatol

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Many different surfactant preparations derived from animal sources, as well as synthetic surfactants, are available for the treatment of preterm infants with respiratory distress syndrome (RDS). Natural, modified surfactants containing surfactant-associated proteins appear to be more effective than non-protein-containing synthetic surfactants. Comparative trials with poractant alfa at a higher initial dose of 200 mg/kg appear to be associated with rapid weaning of FiO 2 , less need for additional doses, and decreased mortality in infants <32 weeks gestation when compared with beractant. Early rescue (<30 min of age) surfactant therapy is an effective method to minimize over treatment of some preterm infants who may not develop RDS. Surfactant therapy followed by rapid extubation to nasal ventilation appears to be more beneficial than continued mechanical ventilation. In near-term or term newborns with acute RDS, surfactant therapy has been shown to be 70% effective in improving respiratory failure.

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Section: Surfactant Therapy and Nasal Continuous Positive Airway Presmentioning

confidence: 99%

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Ramanathan

2006

J Perinatol

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“…(1-4) Among the various strategies used to fight ARDS, treatment with exogenous surfactant is supported by the strongest experimental evidence: in many animal models of ARDS, (5)(6)(7)(8)(9) and in children with ARDS, (1,4,(10)(11)(12) it is clearly evident that synthesis of surfactant is decreased while surfactant inactivation and consumption is increased. The alveoli of ARDS children show a lack of surfactant active forms (large aggregates) and an increase in small aggregates that are the catabolic products of surfactant and are functionally inactive.…”

Section: Introductionmentioning

confidence: 96%

“…The alveoli of ARDS children show a lack of surfactant active forms (large aggregates) and an increase in small aggregates that are the catabolic products of surfactant and are functionally inactive. (4) This impairment in surfactant function is closely associated with alterations in pulmonary function that characterize children with ARDS. (4) Although in animal models the administration of exogenous surfactant is able to change the course of ARDS, when it is studied in children its beneficial effect is weak or totally absent.…”

Section: Introductionmentioning

confidence: 99%

“…(4) Although in animal models the administration of exogenous surfactant is able to change the course of ARDS, when it is studied in children its beneficial effect is weak or totally absent. (4)(5)(6)(7)(8)(9)(10)(11)(12) We would like to analyze the reasons for this, focusing our attention on dosage, modality of administration and type of surfactant used. ARDS is different from HMD and treatment differs.…”

Section: Introductionmentioning

confidence: 99%

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Exogenous Surfactant Treatment in Children with ARDS

2013

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“…ALI results from a variety of insults as diverse as meconium aspiration in newborns, hydrochloric acid reflux, sepsis, and ventilator trauma. In turn, injury predisposes the patient to acute (or adult) respiratory distress syndrome (ARDS) (1)(2)(3)(4). Pulmonary surfactant replacement, now a mainstay in the treatment of respiratory distress syndrome in premature infants, has not enjoyed comparable success in treating ARDS (5)(6)(7).…”

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confidence: 99%

Polyethylene Glycol-Surfactant for Lavage Lung Injury in Rats

Dehority

Clements

et al. 2005

Pediatr Res

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Addition of ionic and nonionic water-soluble polymers to pulmonary surfactants in the presence of inactivating substances prevents surfactant inactivation in vitro and improves lung function in several models of lung injury. However, a recent report found opposite effects when surfactant plus polyethylene glycol (PEG) was used to treat lung injury caused by saline lung lavage. Therefore, we examined the reasons why the polymer effect is less evident in the saline lung lavage lung injury model. We treated rats with lavage lung injury with a commercial lung surfactant extract derived from bovine lung (Survanta) with or without addition of PEG. Groups treated with Survanta ϩ PEG had significantly higher static post mortem lung volumes than groups treated with Survanta. However, groups treated with Survanta ϩ PEG had more tracheal fluid and no significant benefit in arterial oxygenation compared with the group treated with Survanta, despite our use of measures to reduce pulmonary edema. Measurements after intravascular injections of 125 I-labeled albumin confirmed that addition of PEG increased extravascular lung water and that this effect is mitigated by furosemide. We conclude that surfactant ϩ PEG mixtures are less effective in lavage injury than in other forms of lung injury because of increased extravascular lung water. ALI results from a variety of insults as diverse as meconium aspiration in newborns, hydrochloric acid reflux, sepsis, and ventilator trauma. In turn, injury predisposes the patient to acute (or adult) respiratory distress syndrome (ARDS) (1-4). Pulmonary surfactant replacement, now a mainstay in the treatment of respiratory distress syndrome in premature infants, has not enjoyed comparable success in treating ARDS (5-7). Inadequate dosage or distribution, and inactivation of surfactant have been postulated for its poor performance in treating these injuries (8 -11).Multiple reports indicate improved surfactant function when polymers such as dextrans, PEG, and hyaluronan are added to surfactant preparations in vitro (12-15). Animals with ALI have improved lung function when treated with surfactant polymer mixtures versus surfactant alone. found that adult rats receiving surfactant ϩ PEG, dextran, or hyaluronan mixtures have better gas exchange, pulmonary mechanics, and histologic appearance of the lungs when compared with rats treated with Survanta (beractant) alone after HCl-, meconium-, and endotoxin-induced lung injuries. Kobayashi et al. (19,20) have shown that addition of dextran to surfactant improves responses in two additional lung injury models (albumin inhibition in immature rabbits and acid milk aspiration in rats).The specific model used to induce ALI, however, may affect treatment responses to surfactant and surfactant ϩ PEG, as different models of lung injury produce different alveolar environments. A lavage model of lung injury, for example, removes variable amounts of alveolar surfactant (21), whereas a meconium model of lung injury inactivates but does not remove surfactant. P...

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Role of exogenous surfactant in acute lung injury

Cited by 59 publications

References 27 publications

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Exogenous Surfactant Treatment in Children with ARDS

Polyethylene Glycol-Surfactant for Lavage Lung Injury in Rats

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