Document Detail


Bronchoscopic administration of bovine natural surfactant in ARDS and septic shock: impact on gas exchange and haemodynamics.
MedLine Citation:
PMID:  12030717     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aim of the present study was to investigate the feasibility and efficacy of bronchoscopic surfactant administration in a noncontrolled multicentre study in five university centres. A total number of 27 patients, suffering from severe acute respiratory distress syndrome (mean+/-SEM lung injury score: 3.15+/-0.06) and septic shock (Acute Physiology and Chronic Health Evaluation (APACHE) II score at study entry 33.2+/-1.3, lactate 4.3+/-0.6 mmol x L(-1)) were studied. The patients were ventilated with a mean tidal volume of 11.0+/-0.5 mL x kg(-1) body weight (bw), either volume or pressure controlled, with 16.3+/-2.8 cmH2O positive end-expiratory pressure, for an average of 3.5+/-0.3 days at study entry. A natural bovine surfactant extract (300 mg x kg(-1) bw Alveofact; mean total volume 378 mL) was delivered in divided doses to each segment of the lungs via flexible bronchoscope within approximately 45 min. No untoward effects on gas exchange, lung mechanics and haemodynamics were noted during the procedure of surfactant administration. Within 12 h the oxygen tension in arterial blood/inspiratory oxygen fraction increased from a mean of 109+/-8 mmHg to 210+/-20 mmHg (p<0.001). In seven patients, in whom gas exchange again deteriorated with further progression of the disease, a second surfactant dose of 200 mg x kg(-1) was administered 18-24 h after the first application, again improving arterial oxygenation. A total of 15 patients survived the 28-day study period (mortality rate 44.4%, compared to a calculated risk of death for the given APACHE II scores of 74.0+/-3.5%), with all causes of death being nonrespiratory. The bronchoscopic application of a high dose of natural surfactant in patients with severe acute respiratory distress syndrome and septic shock is both feasible and safe, resulting in a pronounced improvement in gas exchange.
Authors:
D Walmrath; F Grimminger; D Pappert; C Knothe; U Obertacke; A Benzing; A Günther; T Schmehl; H Leuchte; W Seeger
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The European respiratory journal     Volume:  19     ISSN:  0903-1936     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-05-27     Completed Date:  2002-12-03     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  805-10     Citation Subset:  IM    
Affiliation:
Dept of Internal Medicine II, Justus-Liebig-University, Giessen, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid / chemistry
Bronchoscopy*
Female
Hemodynamics / drug effects*
Humans
Male
Middle Aged
Pilot Projects
Pulmonary Gas Exchange / drug effects*
Pulmonary Surfactants / administration & dosage*
Respiratory Distress Syndrome, Adult / complications,  drug therapy*
Shock, Septic / complications,  drug therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants
Comments/Corrections
Comment In:
Eur Respir J. 2002 May;19(5):787-9   [PMID:  12030713 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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