Document Detail


Selective medicated (saline + natural surfactant) bronchoalveolar lavage in unilateral lung contusion. A clinical randomized controlled trial.
MedLine Citation:
PMID:  20012912     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Open lung and low tidal volume ventilation appear to be a promising ventilation for chest trauma as it can reduce ARDS and improve outcome. Local therapy (e.g. BAL) can be synergic to remove from the lung the debris, mitigate inflammatory cascade and avoid damage spreading to not compromised lung areas. MATERIALS AND METHODS: 44 pulmonary contused patients were randomized to receive broncho-suction and volume controlled low tidal volume ventilation-VCLTVV (Control Group) or the same ventilation plus medicated (saline + surfactant) BAL (Treatment Group). Tidal volume <10 ml/kg, PEEP of 10-12 cm H(2)O and PaO(2) 60-100 mm Hg and PaCO(2) 35-45 mm Hg were used in both groups. BAL was performed using a fiberscope. 4 boluses of 25 ml saline with 2.4 mg/ml of surfactant were introduced into each contused lobe in which, subsequently, 240 mg of surfactant was instilled. RESULTS: All patients survived. In the Control Group 18 patients developed pneumonia, 5 ARDS and days of intubation were 11.50 (3.83) compared to 5.05 (1.21) of Treatment Group in which OI and PaO(2)/FiO(2) significantly improved from 36 h. CONCLUSIONS: VCLTVV alone was not able to prevent ARDS and infection in the Control Group as the reduction of intubation. In the Treatment Group, VCLTVV and medicated BAL facilitated the removal of degradated lung material and recruited the contused lung regions, enabling the healing of the lung pathology.
Authors:
Giuseppe A Marraro; Carmelo Denaro; Claudio Spada; Marco Luchetti; Carla Giansiracusa
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2009-12-13
Journal Detail:
Title:  Journal of clinical monitoring and computing     Volume:  24     ISSN:  1573-2614     ISO Abbreviation:  J Clin Monit Comput     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-16     Completed Date:  2010-05-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9806357     Medline TA:  J Clin Monit Comput     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  73-81     Citation Subset:  IM    
Affiliation:
Anesthesia and Intensive Care Department, A.O. Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy. gmarraro@picu.it
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MeSH Terms
Descriptor/Qualifier:
Acute Lung Injury / physiopathology,  therapy*
Adult
Aged
Bronchoalveolar Lavage / methods*
Contusions / physiopathology,  therapy*
Endpoint Determination
Female
Humans
Male
Middle Aged
Pneumonia / prevention & control
Positive-Pressure Respiration
Pulmonary Surfactants / administration & dosage*
Respiration, Artificial
Respiratory Distress Syndrome, Adult / prevention & control
Sodium Chloride / administration & dosage*
Suction
Tidal Volume
Young Adult
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants; 7647-14-5/Sodium Chloride

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


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