Role of high-frequency ventilation in surfactant-depleted lung injury as measured by granulocytes

Matsuoka, T.; Kawano, Tsuyoshi; Miyasaka, Katsuyuki

doi:10.1152/jappl.1994.76.2.539

Cited by 69 publications

(36 citation statements)

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“…The activity of surfactant is improved when hydrophobic surfactant proteins are constituents of the surfactant [109], whereas positive end-expiratory pressure (PEEP) improved the response to supplied surfactant [265,277,284]. The application of high frequency oscillatory ventilation may be useful for the prevention of lung injury (especially air leak syndrome) [125,142,203] and does not alter the turnover of surfactant [340]. In animal experiments it has been demonstrated that intraamniotic surfactant is taken up from the amniotic fluid [89].…”

Section: Therapeutic Use Of Surfactantmentioning

confidence: 99%

The Pulmonary Surfactant System: Biochemical and Clinical Aspects

Creuwels

Golde

Haagsman

1997

Lung

282

188

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Abstract. This article starts with a brief account of the history of research on pulmonary surfactant. We will then discuss the morphological aspects and composition of the pulmonary surfactant system. We describe the hydrophilic surfactant proteins A and D and the hydrophobic surfactant proteins B and C, with focus on the crucial roles of these proteins in the dynamics, metabolism, and functions of pulmonary surfactant. Next we discuss the major disorders of the surfactant system. The final part of the review will be focused on the potentials and complications of surfactant therapy in the treatment of some of these disorders. It is our belief that increased knowledge of the surfactant system and its functions will lead to a more optimal composition of the exogenous surfactants and, perhaps, widen their applicability to treatment of surfactant disorders other than neonatal respiratory distress syndrome.Key words: Surfactant protein-Pulmonary surfactant-Respiratory distress syndrome. HistoryResearch on surfactant goes back to 1929 when von Neergaard published the first paper about the difference in pressure needed to inflate lungs with air or with liquid [333]. He found that the pressure necessary for filling the lungs with air was higher than when the lungs were filled with liquid. To explain this result he stated that the alveoli were stabilized by lowering the naturally high surface tension of the air/water interface. In 1946 Thannhauser and co-workers reported that lung tissue has a remarkably high content of the lipid dipalmityl lecithin (current name, dipalmitoylphosphatidylcholine)Offprint requests to: Henk P. Haagsman.

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Section: Therapeutic Use Of Surfactantmentioning

confidence: 99%

The Pulmonary Surfactant System: Biochemical and Clinical Aspects

Creuwels

Golde

Haagsman

1997

Lung

282

188

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“…Mean airway pressure was set initially 0.3 kPa (3 cm H 2 O) higher than during conventional ventilation. Airway pressure was increased every 10-15 min in increments of 0.1 to 0.2 kPa (1-2 cm H 2 O) until a Pa,o 2 of 1 53 kPa (400 mm Hg), an 'optimized' value taken from the literature [17,20,21,25]. Oscillatory frequency was maintained at 10 Hz.…”

Section: Experimental Protocolmentioning

confidence: 99%

“…Indeed, repeated saline lung lavage yields a widely accepted animal model of respiratory insufficiency suitable for the evaluation of respiratory therapeutics [19]. The study design looks much like previously published studies evaluating the short term effects of HFOV [17,20,21] and PLV [3]. Our protocol, however, prescribed adjustment of ventilator settings as clinically indicated in all study groups.…”

Section: Introductionmentioning

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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“…Maintenance of pulmonary volume avoids pulmonary overdistension as well as occurrence of atelectasia in patients with ARDS and the flow standard may improve in relation to ventilation-perfusion. (11,12) Successful treatment of ARDS requires a strategy to keep the lungs open, the open lung approach. Recruitment of collapsed alveoli reduces intrapulmonary shunt, reducing the fraction of inspired oxygen (FiO 2 ) to less toxic concentrations.…”

Section: Clinical Aplications Of Hfov In Pe-diatricsmentioning

confidence: 99%

“…This ventilation mode has been successfully used to treat patients with severe respiratory failure when CMV fails, Furthermore, reports state that when HFOV is used earlier, together with a protective strategy, a decrease of the acute or chronic pulmonary injury occurs in patients with ARDS. (5,10,11) The 3100A by SensorMedics® ventilator is approved by Food and Drug Administration (FDA) for use in children up to 35 kg. This is a device for mechanical pulmonary ventilation with a continuous flow of gas capable of eliminating CO 2 and keeping airway pressure constant.…”

Section: Introductionmentioning

confidence: 99%

Ventilação oscilatória de alta freqüência em pediatria e neonatologia

Fioretto¹,

Rebello²

2009

Rev. bras. ter. intensiva

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This article intends to review literature on high frequency oscillatory ventilation and describe its main clinical applications for children and neonates. Articles from the last 15 years were selected using MedLine and SciElo databases. The following key words were used: high frequency oscillatory ventilation, mechanical ventilation, acute respiratory distress syndrome, children, and new-born. The review describes high frequency oscillatory ventilation in children with acute respiratory distress syndrome, air leak syndrome, and obstructive lung disease. Respiratory distress syndrome, bronchopulmonary dysplasia, intracranial hemorrhage, periventricular leukomalacia, and air leak syndrome were reviewed in neonates. Transition from conventional mechanical ventilation to high frequency ventilation and its adjustments relating to oxygenation, CO 2 elimination, chest radiography, suctioning, sedatives and use of neuromuscular blocking agents were described. Weaning and complications were also reported. For children, high frequency oscillatory ventilation is a therapeutic option, particularly in acute respiratory distress syndrome, and should be used as early as possible. It may be also useful in the air leak syndrome and obstructive pulmonary disease. Evidence that, in neonates, high frequency oscillatory ventilation is superior to conventional mechanical ventilation is lacking. However there is evidence that better results are only achieved with this ventilatory mode to manage the air leak syndrome.

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Role of high-frequency ventilation in surfactant-depleted lung injury as measured by granulocytes

Cited by 69 publications

References 0 publications

The Pulmonary Surfactant System: Biochemical and Clinical Aspects

The Pulmonary Surfactant System: Biochemical and Clinical Aspects

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

Ventilação oscilatória de alta freqüência em pediatria e neonatologia

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