BACKGROUND: To compare the combined effects of arteriovenous extracorporeal lung assist (AV-ECLA) and high-frequency oscillatory ventilation (HFOV) on pulmonary gas exchange, hemodynamics, and respiratory parameters in a lavage-induced porcine lung injury model. METHODS: A prospective, randomized animal study. Saline lung lavage was performed in 33 healthy female pigs, weighing 52 ...

In a recent meta-analysis, surfactant administration in paediatric acute respiratory failure was associated with improved oxygenation, reduced mortality, increased ventilator-free days and reduced duration of ventilation. Surfactant is expensive, however, and its use involves installation of large volumes into the lungs, resulting in transient hypoxia and hypotension in some patients. ...

BACKGROUND: Negative air pressure ventilation has been used to maintain adequate functional residual capacity in patients with chronic muscular disease and to decrease transpulmonary pressure and improve cardiac output during right heart surgery. High-frequency oscillation (HFO) exerts beneficial effects on gas exchange in neonates with acute respiratory failure. We examined ...

Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the recommendations of a European panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. Strong evidence exists for the role of antenatal steroids ...

OBJECTIVE: Delayed surfactant treatment (>2 hrs after birth) is less effective than early treatment in conventionally ventilated preterm infants with respiratory distress syndrome. The objective of this study was to evaluate if this time-dependent efficacy of surfactant treatment is also present during open lung ventilation. DESIGN: Prospective, randomized controlled animal ...

OBJECTIVE: To describe the beneficial clinical effect of the use of surfactant in a patient with severe unilateral pulmonary hemorrhage after iatrogenic lung injury during corrective surgery for congenital heart defects. DESIGN: Case report. SETTING: Pediatric cardiac intensive care unit of a tertiary care hospital. PATIENT: An 11-wk-old boy. INTERVENTIONS: ...

RATIONALE: Hyperoxic ventilation in the management of persistent pulmonary hypertension of the newborn (PPHN) can result in the formation of reactive oxygen species, such as superoxide anions, which can inactivate nitric oxide (NO) and cause vasoconstriction and oxidation. OBJECTIVE: To compare the effect of intratracheal recombinant human superoxide dismutase (rhSOD) ...

To evaluate the role of pulmonary surfactant in the prevention of lung injury caused by mechanical ventilation (MV) at low end-expiratory volumes, lung mechanics and morphometry were assessed in three groups of eight normal, open-chest rabbits ventilated for 3-4 h at zero end-expiratory pressure (ZEEP) with physiological tidal volumes (Vt ...

BACKGROUND: Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury (VILI). Tracheal gas insufflation (TGI) is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume (V(T)) while ...

Our aim was to determine whether antenatal corticosteroids improve perinatal adaptation of the pulmonary circulation in lambs with lung hypoplasia (LH). LH was induced in 12 ovine fetuses between 105 and 140 days gestation (term approximately 147 days); in 6 of these the ewe was given a single dose of ...

OBJECTIVE: To investigate the effects of recombinant human activated protein C (rhAPC) on pulmonary function in acute lung injury (ALI) resulting from smoke inhalation in association with a bacterial challenge. DESIGN: Prospective, randomized, controlled, experimental animal study with repeated measurements. SETTING: Investigational intensive care unit at a university hospital. SUBJECTS: ...

AIM: To evaluate the administration of an equimolar mixture of N2O and O2 for intratracheal intubation in preterm neonates with respiratory distress syndrome (RDS). DESIGN: Prospective evaluation of N2O/O2 in premature neonates with RDS. SETTING: Tertiary neonatal unit from March to August 2003. PATIENTS: Twenty-six of 79 neonates admitted for ...

OBJECTIVE: To report a case of a man who developed temporary hypotension after aerosolized colistin administration. CASE SUMMARY: A 62-year-old Arab male was admitted to the intensive care unit for respiratory failure and septic shock. Simultaneous therapy using intravenous and aerosolized colistin was initiated for the management of multidrug-resistant Pseudomonas ...

RATIONALE: Although surfactant replacement therapy is an established treatment in infant respiratory distress syndrome, the optimum strategy for ventilatory management before, during, and after surfactant instillation remains to be elucidated. OBJECTIVES: To determine the effects of surfactant and lung volume recruitment on the distribution of regional lung ventilation. METHODS: Acute ...

BACKGROUND: The influence of deep hypothermia with either circulatory arrest (DHCA) or low-flow (DHLF) perfusion on pulmonary surfactant metabolism in neonates undergoing cardiac surgery remains unknown. This study was conducted to determine the influence of either strategy on surfactant metabolism and pulmonary function with neonatal piglet model. METHODS: Sixteen piglets ...

RATIONALE: Changes in oxygenation are often used to guide the recruitment procedure during open lung high-frequency ventilation in preterm infants. However, data on the feasibility and safety of this approach in daily clinical practice are limited. OBJECTIVE: To prospectively collect data on ventilator settings, gas exchange, and circulatory parameters before ...

In a surfactant-depletion model of lung injury, tidal recruitment of atelectasis and changes in shunt fraction lead to large Pao2 oscillations. We investigated the effect of these oscillations on conventional arterial blood gas (ABG) results using different sampling techniques in ventilated rabbits. In each rabbit, 5 different ventilator settings were ...

Leukotriene-generated effects on microvascular integrity and polymorphonuclear leukocytes (PMNL) play a key role in the inflammatory process of the alveolar-capillary unit in neonatal acute respiratory distress syndrome. We asked if intrapulmonary application of MK886, a 5-lipoxygenase inhibitor, and the use of a porcine surfactant preparation (Curosurftrade mark) as a carrier ...

The purpose of this study was to examine whether hemoperfusion using polymyxin B (PMX) immobilized column improves hydrochloric acid (HCl)-induced lung injury. Rats weighing 350 g underwent hemoperfusion for 30 min at a flow rate of 120 ml/h after the intratracheal instillation of hydrochloric acid or water. Rats were divided ...

Because little is known about the pathophysiology of invasive pulmonary aspergillosis (IPA), we examined changes in pulmonary and general physiology during this disease in an animal model. In a model of fatal left-sided IPA, 19 persistently neutropenic rats were monitored for clinical signs including body temperature, body weight and respiratory ...

We investigated the effect of surfactant deficiency on airway patency and the effectiveness of surfactant replacement as either an instilled liquid bolus, a non-hygroscopic aerosol or a hygroscopic aerosol. Small airway patency was assessed in isolated piglet lungs by passing a continuous flow of gas though a cannulated airway. Occlusion ...

OBJECTIVE: In acute respiratory distress syndrome, the relationships between changes in the elastic behavior of the respiratory system and biological markers of extra-cellular matrix or surfactant turn-over could give some insights into its pathophysiological determinants. DESIGN AND MEASUREMENTS: In 17 patients with acute respiratory distress syndrome, we assessed the relationship ...

BACKGROUND: Animal-derived, protein-containing surfactants seem to be superior to protein-free surfactants. Lucinactant, a synthetic surfactant containing a surfactant protein-B peptide analog, has been shown to be effective in animal models and phase II clinical trials. To date, lucinactant has not been compared with an animal-derived surfactant in a premature animal ...

INTRODUCTION: The objective was to study the effects of a novel lung volume optimization procedure (LVOP) using high-frequency oscillatory ventilation (HFOV) upon gas exchange, the transpulmonary pressure (TPP), and hemodynamics in a porcine model of surfactant depletion. METHODS: With institutional review board approval, the hemodynamics, blood gas analysis, TPP, and ...

BACKGROUND: Inspiratory activity is a prerequisite for successful application of patient triggered ventilation such as proportional assist ventilation (PAV). It has recently been reported that surfactant instillation increases the activity of slowly adapting pulmonary stretch receptors (PSRs) followed by a shorter inspiratory time (Sindelar et al, J Appl Physiol, 2005 ...

Surfactant therapy does not lead to a uniform, optimal and sustained effect on gas exchange in neonatal respiratory distress syndrome (RDS) and acute respiratory distress syndrome (ARDS). The aim of the present study therefore was to compare the effects of a lipid-enriched and protein-modified natural surfactant preparations with a licensed, ...

BACKGROUND: To evaluate the efficacy and safety of bronchoalveolar lavage (BAL) with diluted porcine surfactant in mechanically ventilated term infants with severe acute respiratory distress syndrome (ARDS) due to meconium aspiration syndrome (MAS). METHODS: Eight consecutive mechanically ventilated term infants with severe ARDS due to MAS underwent BAL with 15 ...

BACKGROUND: To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. METHODS: Severe lung injury (Ali) was induced in 18 healthy pigs (55.3 ...

INTRODUCTION: The objective was to study the effects of a lung recruitment procedure by stepwise increases of mean airway pressure upon organ blood flow and hemodynamics during high-frequency oscillatory ventilation (HFOV) versus pressure-controlled ventilation (PCV) in experimental lung injury. METHODS: Lung damage was induced by repeated lung lavages in seven ...

A nonionic-methylated branched hydrocarbon surfactant, octa(ethylene glycol) 2,6,8-trimethyl-4-nonyl ether (5b-C12E8) emulsifies up to 90% CO2 in water with polyhedral cells smaller than 10 microm, as characterized by optical microscopy. The stability of these concentrated CO2/water (C/W) emulsions increases with pressure and in some cases exceeds 24 h. An increase in ...

BACKGROUND/PURPOSE: The aims of this study were to analyze the outcomes of fetuses with congenital diaphragmatic hernia (CDH) treated by a lung-protective strategy using high-frequency oscillatory ventilation (HFOV) in a single center with a perinatology service and extracorporeal membrane oxygenation (ECMO) capability and to define the natural history of CDH ...

Single units of slowly adapting pulmonary stretch receptors (PSRs) were investigated in anesthetized cats during spontaneous breathing on continuous positive airway pressure (2-5 cmH2O), before and after lung lavage and then after instillation of surfactant to determine the PSR response to surfactant replacement. PSRs were classified as high threshold (HT) ...

OBJECTIVE: Both prone position and high-frequency oscillatory ventilation (HFOV) have the potential to facilitate lung recruitment, and their combined use could thus be synergetic on gas exchange. Keeping the lung open could also potentially be lung protective. The aim of this study was to compare physiologic and proinflammatory effects of ...

OBJECTIVE: This study was designed to investigate the effectiveness of using various devices and manual procedures for cleansing bacterially contaminated bone tissue and to assess the risk of iatrogenic bacterial seeding in deep bone layers. METHODS: In an in vitro model, human femoral heads were contaminated with Escherichia coli and ...

A 50-year-old man with chronic otitis media was admitted to our hospital for investigation of lung cancer. He had received repeated instillations of fibrin sealant (Bolheal) in myringoplasty 7 times over 12 months. During the lower lobectomy, soon after fibrin sealant was applied to seal bronchopleural fistulas, systolic blood pressure ...

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 ...

RATIONALE: The role of the patent ductus arteriosus in the development of chronic lung disease in surfactant-treated premature newborns remains unclear. OBJECTIVE: To examine the effects of ductus ligation on cardiopulmonary function and lung histopathology in premature primates. METHODS: Baboons were delivered at 125 d, (term = 185 d) treated ...

BACKGROUND AND OBJECTIVES: Different types of surfactant preparations were shown not to exert uniform response in preterm infants suffering from respiratory distress syndrome (RDS). Therefore, the effects of a recombinant surfactant protein C (rSP-C) based preparation and a natural surfactant were compared applying different levels of positive end-expiratory pressure (PEEP) ...

This study tested the hypothesis that material leaking into the airspace from the vasculature during ventilation interferes with surfactant function and contributes to decreases in lung compliance. Rats were euthanized and the lungs were isolated either with or without flushing of the vasculature, followed by mechanical ventilation and analysis of ...

We have previously shown that surface lesions and acute necrosis of chondrocytes are produced by severe levels of blunt mechanical load, generating contact pressures greater than 25 MPa, on chondral and osteochondral explants. We have also found surface lesions and chronic degradation of retro-patellar cartilage within 3 years following a ...

Hyaluronan (HA), an ionic polymer, is normally present in the alveolar subphase and is known to decrease lung surfactant inactivation caused by serum in vitro. In this study, we examined whether HA can ameliorate the inactivating effects of meconium in vitro and in vivo. Surface activities of various mixtures of ...

Governing mechanisms of dense non-aqueous phase liquid (DNAPL) removal during surfactant and surfactant-foam (SF) flooding were studied by porous-patterned glass model experiments. Physical forces, viscous forces and capillary forces, acting on trichloroethylene (TCE) blobs were quantified to understand DNAPL removal mechanisms during the floods, simultaneously visualizing the removal mechanisms. The ...

This study explored, the inflammatory response during experimental pneumonia in surfactant-depleted animals as a function of ventilation strategies and surfactant treatment. Following intratracheal instillation of Group B streptococci (GBS), surfactant-depleted piglets were treated with conventional (positive-end expiratory pressure (PEEP) of 5 cmH2O, tidal volume 7 mL x kg(-1)) or open ...

RATIONALE: Oxidant stress may increase the severity of respiratory distress syndrome (RDS) after premature birth by altering vasoreactivity and increasing lung edema, but the acute effects of superoxide dismutase (SOD) treatment on gas exchange, lung compliance (CL), and pulmonary vascular resistance in premature animals with RDS are unknown. OBJECTIVE: We ...

Acute respiratory distress syndrome is occasionally seen in newborn infants due to a severe inflammatory process in the lungs that affects capillary-alveolar permeability, epithelial integrity, and type I and II pneumocyte function. The aim of this study was to investigate the effect of a topically applied nuclear factor-kappaB inhibitor (IkappaB ...

BACKGROUND: Meconium aspiration-induced hypertensive lung injury has been associated with neuronal damage in the newborn, but the mechanisms of the injury are poorly known. AIMS: The aim of the study was to determine the contribution of oxidative stress to the brain damage after pulmonary meconium contamination. STUDY DESIGN: Sixteen anesthetized ...

STUDY OBJECTIVE: This study compared the safety profiles of bronchoscopic lavage with nonbronchoscopic lavage in the investigation of patients with acute lung injury (ALI) or ARDS. DESIGN: Single-center, randomized, cross-over study. SETTING: General ICU in the United Kingdom. PARTICIPANTS: Fourteen patients with ALI or ARDS. INTERVENTIONS: Bronchoscopic BAL and nonbronchoscopic ...

Much of the information on the physiologic effects, mechanisms of gas exchange, and potential utility of high-frequency oscillation (HFO) has been acquired in animal studies. Specifically, large animal data have been useful in assessing adult application because large animals present many of the same concerns and challenges as adults. To ...

In preterm infants with respiratory distress syndrome, surfactant administration followed by immediate extubation to spontaneous breathing with nasal continuous positive airway pressure reduces the need for mechanical ventilation. With this treatment approach, repeated doses of surfactant are rarely indicated. We used a rabbit model to test the hypothesis that exogenous ...

Monolayer properties such as phase behavior, collapse pressure, and surface viscosity are determined by monolayer composition. Learning how to control these properties through simple additives is important to understanding lung surfactant monolayers and to designing optimal replacement surfactants for treatment of disease. The properties of Infasurf, a replacement lung surfactant ...