Pre- versus post-ventilatory surfactant treatment in surfactant-deficient preterm lambs

1995 ◽  
Vol 7 (5) ◽  
pp. 1333 ◽  
Author(s):  
JJ Cummings ◽  
BA Holm ◽  
PA Nickerson ◽  
WH Ferguson ◽  
EA Egan
Keyword(s):  
Lung Function ◽  
Lung Surfactant ◽  
Efficiency Index ◽  
Mechanically Ventilated ◽  
Hyaline Membrane ◽  
Surfactant Administration ◽  
Lung Liquid ◽  
To Receive ◽  
Uniform Deposition ◽  
Over Time

Twenty lambs at 127 days' gestation (term is 145 days) were randomly assigned to receive Infasurf (Calf Lung Surfactant Extract, ONY Inc., Amherst, NY) as an intratracheal bolus (3 mliter kg-1) either into a fluid-filled lung before ventilation (n = 10), or after ventilation for 5 min (n = 10). All lambs were surfactant-deficient by analysis of lung liquid obtained before surfactant administration. Lambs were then mechanically ventilated for 4 h. Oxygenation for the lambs given surfactant before ventilation did not change during the experiment; a/A pO2 was 0.50 +/- 0.13 at 1 h and 0.52 +/- 0.17 at 4 h. For the lambs given surfactant after initial ventilation, oxygenation decreased over time; a/A pO2 decreased from 0.48 +/- 0.23 at 1 h to 0.37 +/- 0.22 at 4 h (P < 0.05). Compliance, as calculated from the Ventilator Efficiency Index (VEI), improved over time in both groups, but was always significantly higher for lambs given surfactant before ventilation (P = 0.03). Histologic examination of the lungs revealed no differences between the groups; no evidence of epithelial denudation or hyaline membrane formation was seen in either group. Thus, ventilation of surfactant-deficient newborn lambs for 5 min before surfactant administration results in significantly decreased lung function when compared with surfactant administration before ventilation. These differences in lung function are not dependent on a histopathologic injury to the lung. It is possible that unevenness of deposition of the surfactant in an air-filled lung, compared to more uniform deposition in a fluid-filled unventilated lung, produces these differences.

Double-Blind Clinical Trial of Calf Lung Surfactant Extract for the Prevention of Hyaline Membrane Disease in Extremely Premature Infants

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 585-592 ◽  
Author(s):  
Melinda S. Kwong ◽  
Edmund A. Egan ◽  
Robert H. Notter ◽  
Donald L. Shapiro
Keyword(s):  
Premature Infants ◽  
Controlled Trial ◽  
Lung Surfactant ◽  
Hyaline Membrane Disease ◽  
Treated Group ◽  
Efficiency Index ◽  
Lung Lavage ◽  
Exogenous Surfactant ◽  
Double Blind ◽  
Hyaline Membrane

A prospective, double-blind, controlled trial was conducted to determine whether instillation of an exogenous surfactant into the lungs before the first breath could prevent hyaline membrane disease. The surfactant is calf lung lipid extracted from saline lung lavage. Entry was limited to infants who were 24 to 28 weeks' gestation, who were born at Children's Hospital of Buffalo, and whose mothers had not received betamethasone for more than 24 hours before birth. Treated infants received 3 mL (90 mg) of calf lung surfactant extract instilled into their trachea before the first breath; control infants received 3 mL of normal saline. A prospective scoring system and respiratory support variables were used to compare the groups. At 48 hours of age, only two of 14 calf lung surfactant extract-treated infants (14%) had hyaline membrane disease compared with seven of 13 control infants (54%) (P = .033). Inspired oxygen, mean airway pressure, ventilator rate and ventilator efficiency index were also lower in the treated group during the first 48 hours of life (P &lt; .01 to P &lt; .001). Calf lung surfactant extract instillation at birth appears to be an effective material and method of preventing hyaline membrane disease in extremely premature infants.

Reduced Incidence of Hyaline Membrane Disease in Extremely Premature Infants Following Delay of Delivery in Mother With Preterm Labor: Use of Ritodrine and Betamethasone

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 767-774
Author(s):  
Melinda S. Kwong ◽  
Edmund A. Egan
Keyword(s):  
Premature Infants ◽  
Controlled Trial ◽  
Lung Surfactant ◽  
Hyaline Membrane Disease ◽  
Treated Group ◽  
Efficiency Index ◽  
Premature Delivery ◽  
Aggressive Approach ◽  
Surfactant Production ◽  
Hyaline Membrane

Data from two groups of infants (24 to 28 weeks' gestational age) excluded from a controlled trial of the use of calf lung surfactant extract for the prevention of hyaline membrane disease are reported. The two groups were excluded from the trial because the mothers had received betamethasone for greater than 24 hours prior to delivery or because, on admission to the hospital, labor was too far advanced for proper informed consent to enter the trial. Attempts were made to delay delivery of threatened premature labor by the use of ritodrine in all mothers without evidence of infection, heavy vaginal bleeding, or severe preeclampsia and to induce surfactant production by maternal injection of betamethasone. A prospective scoring system and respiratory support variables were used to compare the groups. Infants born to mothers who successfully completed this regimen had a 28% incidence of hyaline membrane disease v a 68% incidence in infants in whose mothers it was unsuccessful due to inability to stop advanced labor (P = .001). Inspired oxygen, mean airway pressure, and ventilator rate were lower and the ventilator efficiency index was higher in the treated group during the first 48 hours of life. An aggressive approach to postpone premature delivery and to induce surfactant production by using tocolysis and a regimen of glucocorticoids reduces the incidence of hyaline membrane disease in very premature infants, 24 to 28 weeks' gestation.

Frühgeborene unter maschineller Beatmung: Immunmodulatorischer Effekt der präventiven Gabe von Azithromycin

2020 ◽  
pp. 1-3
Author(s):  
Maximilian Jorczyk
Keyword(s):  
Very Low Birth Weight ◽  
Controlled Trial ◽  
Preterm Neonates ◽  
Double Blind ◽  
Mechanically Ventilated ◽  
Before And After ◽  
Anti Inflammatory ◽  
To Receive ◽  
Therapeutic Possibilities ◽  
Inflammatory Effect

<b>Introduction:</b> Macrolides have anti-inflammatory and immunomodulatory properties that give this class of antibiotics a role that differs from its classical use as an antibiotic, which opens new therapeutic possibilities. <b>Objective:</b> The aim of this study was to evaluate the anti-inflammatory effect of azithromycin in preventing mechanical ventilation (MV)-induced lung injury in very-low-birth-weight preterm neonates. <b>Methods:</b> This is a randomized, double-blind, placebo-controlled trial of preterm neonates who received invasive MV within 72 h of birth. Patients were randomized to receive intravenous azithromycin (at a dose of 10/mg/kg/day for 5 days) or placebo (0.9% saline) within 12 h of the start of MV. Two blood samples were collected (before and after intervention) for measurement of interleukins (ILs) and PCR for <i>Ureaplasma</i>. Patients were followed up throughout the hospital stay for the outcomes of death and bronchopulmonary dysplasia defined as need for oxygen for a period of ≥28 days of life (registered at ClinicalTrials.gov, No. NCT03485703). <b>Results:</b> Forty patients were analyzed in the azithromycin group and 40 in the placebo group. Five days after the last dose, serum IL-2 and IL-8 levels dropped significantly in the azithromycin group. There was a significant reduction in the incidence of death and O<sub>2</sub> dependency at 28 days/death in azithromycin-treated patients regardless of the detection of <i>Ureaplasma</i> in blood. <b>Conclusions:</b> Azithromycin has anti-inflammatory effects, with a decrease in cytokines after 5 days of use and a reduction in death and O<sub>2</sub> dependency at 28 days/death in mechanically ventilated preterm neonates.

scholarly journals Preemptive ganciclovir for mechanically ventilated patients with cytomegalovirus reactivation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laurent Papazian ◽  
◽  
Samir Jaber ◽  
Sami Hraiech ◽  
Karine Baumstarck ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Double Blind ◽  
Intravenous Ganciclovir ◽  
Subdistribution Hazard ◽  
Mechanically Ventilated ◽  
Cytomegalovirus Reactivation ◽  
Secondary Outcomes ◽  
To Receive ◽  
Cmv Reactivation

Abstract Background The effect of cytomegalovirus (CMV) reactivation on the length of mechanical ventilation and mortality in immunocompetent ICU patients requiring invasive mechanical ventilation remains controversial. The main objective of this study was to determine whether preemptive intravenous ganciclovir increases the number of ventilator-free days in patients with CMV blood reactivation. Methods This double-blind, placebo-controlled, randomized clinical trial involved 19 ICUs in France. Seventy-six adults ≥ 18 years old who had been mechanically ventilated for at least 96 h, expected to remain on mechanical ventilation for ≥ 48 h, and exhibited reactivation of CMV in blood were enrolled between February 5th, 2014, and January 23rd, 2019. Participants were randomized to receive ganciclovir 5 mg/kg bid for 14 days (n = 39) or a matching placebo (n = 37). Results The primary endpoint was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included day 60 mortality. The trial was stopped for futility based on the results of an interim analysis by the DSMB. The subdistribution hazard ratio for being alive and weaned from mechanical ventilation at day 60 for patients receiving ganciclovir (N = 39) compared with control patients (N = 37) was 1.14 (95% CI from 0.63 to 2.06; P = 0.66). The median [IQR] numbers of ventilator-free days for ganciclovir-treated patients and controls were 10 [0–51] and 0 [0–43] days, respectively (P = 0.46). Mortality at day 60 was 41% in patients in the ganciclovir group and 43% in the placebo group (P = .845). Creatinine levels and blood cells counts did not differ significantly between the two groups. Conclusions In patients mechanically ventilated for ≥ 96 h with CMV reactivation in blood, preemptive ganciclovir did not improve the outcome.

scholarly journals Species pattern of phosphatidylinositol from lung surfactant and a comparison of the species pattern of phosphatidylinositol and phosphatidylglycerol synthesized de novo in lung microsomal fractions

1988 ◽  
Vol 254 (1) ◽  
pp. 67-71 ◽  
Author(s):  
B Rüstow ◽  
Y Nakagawa ◽  
H Rabe ◽  
K Waku ◽  
D Kunze
Keyword(s):  
Lung Function ◽  
Molecular Species ◽  
De Novo ◽  
Lung Surfactant ◽  
Minor Component ◽  
Main Species ◽  
Surfactant Phospholipids ◽  
Species Pattern ◽  
A Minor

1. Phosphatidylinositol (PI) is a minor component of lung surfactant which may be able to replace the functionally important phosphatidylglycerol (PG) [Beppu, Clements & Goerke (1983) J. Appl. Physiol. 55, 496-502] without disturbing lung function. The dipalmitoyl species is one of the main species for both PI (14.4%) and PG (16.9%). Besides the C16:0--C16:0 species, the C16:0--C18:0, C16:0--C18:1, C16:0--C18:2 and C18:0--C18:1 species showed comparable proportions in the PG and PI fractions. These similarities of the species patterns and the acidic character of both phospholipids could explain why surfactant PG may be replaced by PI. 2. PI and PG were radiolabelled by incubation of microsomal fractions with [14C]glycerol 3-phosphate (Gro3P). For 11 out of 14 molecular species of PI and PG we measured comparable proportions of radioactivity. The radioactivity of these 11 species accounted together for more than 80% of the total. The addition of inositol to the incubation system decreased the incorporation in vitro of Gro3P into PG and CDP-DG (diacylglycerol) of lung microsomes (microsomal fractions), but did not change the distribution of radioactivity among the molecular species of PG. These results supported the idea that both acidic surfactant phospholipids may be synthesized de novo from a common CDP-DG pool in lung microsomes.

Surfactant for Hyaline Membrane Disease

PEDIATRICS ◽  
1980 ◽  
Vol 66 (5) ◽  
pp. 795-798 ◽  
Author(s):  
Tetsuro Fujiwara ◽  
Forrest H. Adams
Keyword(s):  
Premature Infants ◽  
Lung Surfactant ◽  
Hyaline Membrane Disease ◽  
The Other ◽  
Synthetic Surfactant ◽  
Natural Surfactant ◽  
Hyaline Membrane ◽  
Dipalmitoyl Lecithin ◽  
Air Intake ◽  
Relative Deficiency

Since it has been demonstrated that hyaline membrane disease (HMD) is due to a relative deficiency of lung surfactant,1,2 one possible approach to the treatment or prevention of HMD in premature infants might be the introduction of surfactant into the lungs. Thus far, attempts at aerosolization of either synthetic surfactant (dipalmitoyl lecithin [DPL]) or natural surfactant into the lungs of patients or animals have failed to produce convincing benefits.3-5 On the other hand, direct instillation of a solution of natural surfactant into the trachea seems to produce striking results. Enhörning et al6 were the first to show that tracheal deposition of natural surfactant into premature rabbit fetuses before the first breath enhanced air intake and improved the pressure-volume relationships of the lungs; it also increased their survival time.7

Immediate Effects on Lung Function of Instilled Human Surfactant in Mechanically Ventilated Newborn Infants with IRDS

1990 ◽  
Vol 79 (8-9) ◽  
pp. 750-755 ◽  
Author(s):  
K. E. EDBERG ◽  
B. EKSTRÖM-JODAL ◽  
M. HALLMAN ◽  
O. HJALMARSON ◽  
K. SANDBERG ◽  
...  
Keyword(s):  
Lung Function ◽  
Newborn Infants ◽  
Mechanically Ventilated

scholarly journals Magnetic induction pneumography: a planar coil system for continuous monitoring of lung function via contactless measurements

2019 ◽  
Vol 1 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Doğa Gürsoy ◽  
Hermann Scharfetter
Keyword(s):  
Lung Function ◽  
Magnetic Induction ◽  
Continuous Monitoring ◽  
Patient Comfort ◽  
Point Spread Functions ◽  
Mechanically Ventilated ◽  
Planar Coil ◽  
Residual Norm ◽  
Imaging Artifacts ◽  
Internal Conductivity

Abstract Continuous monitoring of lung function is of particular interest to the mechanically ventilated patients during critical care. Recent studies have shown that magnetic induction measurements with single coils provide signals which are correlated with the lung dynamics and this idea is extended here by using a 5 by 5 planar coil matrix for data acquisition in order to image the regional thoracic conductivity changes. The coil matrix can easily be mounted onto the patient bed, and thus, the problems faced in methods that use contacting sensors can readily be eliminated and the patient comfort can be improved. In the proposed technique, the data are acquired by successively exciting each coil in order to induce an eddy-current density within the dorsal tissues and measuring the corresponding response magnetic field strength by the remaining coils. The recorded set of data is then used to reconstruct the internal conductivity distribution by means of algorithms that minimize the residual norm between the estimated and measured data. To investigate the feasibility of the technique, the sensitivity maps and the point spread functions at different locations and depths were studied. To simulate a realistic scenario, a chest model was generated by segmenting the tissue boundaries from NMR images. The reconstructions of the ventilation distribution and the development of an edematous lung injury were presented. The imaging artifacts caused by either the incorrect positioning of the patient or the expansion of the chest wall due to breathing were illustrated by simulations.

scholarly journals Impacted teeth: Their place is in the dental arch

2019 ◽  
Vol 24 (6) ◽  
pp. 20-26 ◽  
Author(s):  
Alberto Consolaro ◽  
Mauricio de Almeida Cardoso
Keyword(s):  
Dental Arch ◽  
Impacted Teeth ◽  
Unerupted Tooth ◽  
Starting Point ◽  
Unerupted Teeth ◽  
To Receive ◽  
Over Time

ABSTRACT The starting point for the treatment of unerupted teeth should consider the fact that, biologically, the pericoronal follicle maintains the ability to release EGF and other mediators responsible for eruption over time. The eruptive events may be guided and directed, so that teeth may occupy the space prepared to receive them in the dental arch, as showed in the case presented to evidence the following principle to be considered in these cases: “Regardless of the position of an unerupted tooth, it may be biologically directed to its place in the dental arch. The orthodontist should apply a mechanics to guide it and park it at its site.”

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