Document Detail


Surfactant rescue in the fetal lamb model of congenital diaphragmatic hernia.
MedLine Citation:
PMID:  8863244     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Surfactant therapy given before the onset of ventilation (surfactant prophylaxis) has been shown to improve oxygenation, ventilation, and pulmonary hemodynamics in the lamb model of congenital diaphragmatic hernia (CDH). The aim of this study was to assess the efficacy of surfactant administered after the onset of ventilation ("surfactant rescue"). Ten lambs with surgically created CDH were instrumented, at full term, to measure pulmonary blood flow and pulmonary vascular resistance (PVR). Catheters also were positioned for monitoring of systemic blood pressure and arterial blood gases. The animals were delivered and pressure-ventilated according to a standard protocol (PIP, 30 cm; PEEP, 4 cm; respiratory rate, 60 breaths per minute). After 30 minutes of ventilation, five animals received an intratracheal dose of calf lung surfactant extract (50 mg/kg). The animals were studied for 4 hours. Surfactant rescue had no discernible effect on Pco2, Pco2, or pH. There was an increase in pulmonary blood flow, but it was not significant. The dramatic improvement in oxygenation, ventilation, and pulmonary blood flow found with prophylactic surfactant cannot be reproduced when surfactant is administered as rescue therapy. This indicates that the surfactant is not being delivered adequately, the lungs have already incurred significant barotrauma, and/or the surfactant is being inactivated by alveolar protein. Therefore, the authors suggest that when exogenous surfactant therapy is being considered for the fetus or newborn with CDH, it should be administered as early as possible, preferably before the infant's first breath. Prenatal diagnosis and delivery in a tertiary care center would facilitate this optimum management.
Authors:
S J O'Toole; H L Karamanoukian; A Sharma; F C Morin; B A Holm; R G Azizkhan; P L Glick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  31     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1997-01-14     Completed Date:  1997-01-14     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1105-8; discussion 1108-9     Citation Subset:  IM    
Affiliation:
Buffalo Institute of Fetal Therapy, Children's Hospital of Buffalo, NY 14222, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Animals, Newborn
Chemotherapy, Adjuvant
Disease Models, Animal
Drug Evaluation, Preclinical
Hernia, Diaphragmatic / congenital*,  drug therapy*
Pulmonary Circulation / drug effects
Pulmonary Gas Exchange / drug effects
Pulmonary Surfactants / therapeutic use*
Respiration, Artificial*
Time Factors
Vascular Resistance / drug effects
Grant Support
ID/Acronym/Agency:
HL 36543/HL/NHLBI NIH HHS; HL 49977/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants

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


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