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Intensive Care Medicine

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01.05.2007 | Brief Report

The effect of exogenous surfactant in patients with lung contusions and acute lung injury

verfasst von: I. Tsangaris, E. Galiatsou, E. Kostanti, G. Nakos

Erschienen in: Intensive Care Medicine | Ausgabe 5/2007

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Abstract

Objective

To investigate the acute effect of surfactant replacement in multiple-trauma patients with lung contusion and acute lung injury.

Design and setting

Prospective randomized clinical trial in the 14-bed ICU of a 750-bed university hospital.

Patients and participants

Sixteen ventilated trauma patients with severe refractory hypoxemia (PaO₂/FIO₂ < 150 mmHg) and lung contusions.

Interventions

Patients were randomly assigned to either surfactant administration (n = 8) or standard treatment (n = 8). A single dose of natural bovine surfactant was instilled bronchoscopically in the involved lung areas; each segmental bronchus received (200/19) mg/kg body weight.

Measurements and results

The surfactant group demonstrated an acute improvement in oxygenation after surfactant replacement compared both to control group and to baseline values. In the surfactant group PaO₂/FIO₂ increased from 100 ± 20 mmHg at baseline to 140 ± 20 (6 h), 163 ± 26 (12 h), and 187 ± 30 mmHg (24 h). Compliance increased from 30 to 36 ml/cmH₂O at 6 h after administration, and this increase remained significant at the 24, 48, and 72 h time points. The surfactant group demonstrated a higher response to recruitment maneuvers than the control group at 6 h. The mean duration of ventilatory support was 5.6 ± 2.6 days in the surfactant group and 8.1 ± 2.4 days in the control group.

Conclusions

Surfactant replacement was well tolerated in patients with lung contusions and severe hypoxemia and resulted in improved oxygenation and compliance.

Obertacke U, Neudeck F, Majetschak M, Hellinger A, Kleinschmidt C, Scade FU, Hogasen K, Jochum M, Strohmeier W, Thurnher M, Redl H, Schlag G (1998) Local and systemic reactions after lung contusion: an experimental study in the pig. Shock 10:7–12CrossRefPubMed

Aufmkolk M, Fischer R, Voggenreiter G, Kleinschmidt C, Schmit-Neuerburg KP, Obertacke U (1999) Local effect of lung contusion on lung surfactant composition in multiple trauma patients. Crit Care Med 27:1441–1446CrossRefPubMed

Hallman M, Spragg R, Harrell JH, Moser KM, Gluck L (1982) Evidence of lung surfactant abnormality in respiratory failure. Study of bronchoalveolar lavage phospholipids, surface activity, phospholipase activity, and plasma myoinositol. J Clin Invest 70:673–683CrossRefPubMedPubMedCentral

Guenther A, Siebert C, Schmidt R, Ziegler S, Grimminger F, Yabut M, Temmesfeld B, Waimrath D, Morr H, Seeger W (1996) Surfactant alterations in severe pneumonia, acute respiratory distress syndrome, and cardiogenic lung edema. Am J Respir Crit Care Med 153:176–184CrossRef

Nakos G, Kitsiouli E, Tsangaris I, Lekka ML (1998) Bronchoalveolar lavage fluid characteristics of early, intermediate and late phase of ARDS: alterations in leukocytes, proteins, PAF and surfactant components. Intensive Care Med 24:296–303CrossRefPubMed

Gregory TJ, Steinberg KP, Spragg R, Gadek JE, Hyers TM, Longmore WJ, Moxley MA, Cai GZ, Hite RD, Smith RM, Hudson LD, Crim C, Newton P, Mitchell BR, Gold AJ (1997) Bovine surfactant therapy for patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 155:1309–1315CrossRefPubMed

Walmrath D, Grimminger F, Pappert D, Knothe C, Obertacke U, Benzing A, Günther A, Schmehl T, Leuchte H, Seeger W (2002) Bronchoscopic administration of bovine natural surfactant in ARDS and septic shock: impact on gas exchange and haemodynamics. Eur Respir J 19:805–810CrossRefPubMed

Spragg RG, Lewis JF, Walmrath HD, Johannigman J, Bellingan G, Laterre PF, Witte M, Richards G, Rippin G, Rathgeb F, Häfner D, Taut F, Seeger W (2004) Effect of recombinant surfactant protein C-based surfactant on the acute respiratory distress syndrome. N Engl J Med 351:884–892CrossRefPubMed

Schulz S, Wiebalck A, Frankenberg C, Sivitanidis E, Zenz M (2000) Low-dose surfactant instillation during extracorporeal membrane oxygenation therapy in a patient with adult respiratory distress syndrome and secondary atelectasis after chest contusion. J Cardiothorac Vasc Anesth 14:59–62CrossRefPubMed

10.

Nakos G, Kitsakos A, Tsangaris H (2005) The effect of exogenous surfactant administration in patients with lung contusion. Intensive Care Med 31:S169CrossRef

11.

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Intensive Care Med 20:225–132CrossRefPubMed

12.

MacIntyre N (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest 120:375S–396SCrossRef

13.

The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRef

14.

Frerichs I, Dargaville P, van Genderingen H, Morel DR, Rimensberger PC (2006) Lung volume recruitment after surfactant administration modifies spatial distribution of ventilation. Am J Respir Crit Care Med 174:772–779CrossRefPubMed

15.

Kaam AH van, Haitsma JJ, Dik WA, Naber BA, Alblas EH, De Jaegere A, Kok JH, Lachmann B (2004) Response to exogenous surfactant is different during open lung and conventional ventilation. Crit Care Med 32:774–780CrossRef

16.

Strohmaier W, Trupka A, Pfeiler C, Thurnher M, Khakpour Z, Gippner-Steppert C, Jochum M, Redl H (2005) Bilateral lavage with diluted surfactant improves lung function after unilateral lung contusion in pigs. Crit Care Med 33:2286–2293CrossRefPubMed

17.

Dimitriou G, Greenough A, Kavadia V (1997) Changes in lung volume, compliance and oxygenation in the first 48 hours of life in infants given surfactant. J Perinat Med 25:49–54CrossRefPubMed

18.

Dinger J, Topfer A, Schaller P, Schwarze R (2002) Functional residual capacity and compliance of the respiratory system after surfactant treatment in premature infants with severe respiratory distress syndrome. Eur J Pediatr 161:485–490PubMed

19.

Willson D, Thomas N, Markovitz B, Bauman LA, DiCarlo JV, Pon S, Jacobs BR, Jefferson LS, Conaway MR, Egan EA (2005) Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA 293:470–476CrossRefPubMed

Titel: The effect of exogenous surfactant in patients with lung contusions and acute lung injury
verfasst von: I. Tsangaris
E. Galiatsou
E. Kostanti
G. Nakos
Publikationsdatum: 01.05.2007
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 5/2007
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0597-z

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Conclusions

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