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Titolo:
IMPROVED OXYGENATION BY NITRIC-OXIDE IS ENHANCED BY PRIOR LUNG REAERATION WITH SURFACTANT, RATHER THAN POSITIVE END-EXPIRATORY PRESSURE, INLUNG-LAVAGED RABBITS
Autore:
GOMMERS D; HARTOG A; VANTVEEN A; LACHMANN B;
Indirizzi:
ERASMUS UNIV ROTTERDAM,DEPT ANESTHESIOL,ROOM EE 2393,POB 1738 NL-3000DR ROTTERDAM NETHERLANDS ERASMUS UNIV ROTTERDAM,DEPT ANESTHESIOL NL-3000 DR ROTTERDAM NETHERLANDS
Titolo Testata:
Critical care medicine
fascicolo: 11, volume: 25, anno: 1997,
pagine: 1868 - 1873
SICI:
0090-3493(1997)25:11<1868:IOBNIE>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS-SYNDROME; PERSISTENT PULMONARY-HYPERTENSION; CONGENITAL DIAPHRAGMATIC-HERNIA; EXOGENOUS SURFACTANT; GAS-EXCHANGE; DOSE-RESPONSE; LAMB MODEL; THERAPY; VENTILATION; INJURY;
Keywords:
RESPIRATORY DISTRESS SYNDROME; PULMONARY SURFACTANTS; NITRIC OXIDE; DISEASE MODELS, ANIMAL; LUNG; PULMONARY GAS EXCHANGE; RESPIRATORY MECHANICS; CRITICAL ILLNESS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
32
Recensione:
Indirizzi per estratti:
Citazione:
D. Gommers et al., "IMPROVED OXYGENATION BY NITRIC-OXIDE IS ENHANCED BY PRIOR LUNG REAERATION WITH SURFACTANT, RATHER THAN POSITIVE END-EXPIRATORY PRESSURE, INLUNG-LAVAGED RABBITS", Critical care medicine, 25(11), 1997, pp. 1868-1873

Abstract

Objectives: The inhalation of nitric oxide increases oxygenation by improving the ventilation/perfusion ratios in neonates with respiratorydistress syndrome and those ratios in adults with acute respiratory distress syndrome. There is evidence that inhaled nitric oxide is ineffective when the lung remains atelectatic and poorly inflated. This study aimed to enhance nitric oxide delivery by improving lung aeration by means of exogenous surfactant or by increasing positive end-expiratory pressure. Design: Experimental, comparative study. Setting: Research laboratory of a large university. Subjects: Twenty-eight adult New Zealand white rabbits, weighing 2.7 +/- 0.3 kg. Interventions: Lung injury was induced by repeated whole lung lavage with saline. The animalswere mechanically ventilated with a tidal volume of 10 mL/kg, an Fio(2) of 1.0, and a positive end expiratory pressure of 6 cm H2O. Forty-five minutes after the last ravage, the animals were randomly assigned to five groups. In two groups, lung aeration was first increased either by instillation of a low dose of exogenous surfactant (25 mg/kg) or by increasing the positive end-expiratory pressure to 10 cm H2O, before inhalation of nitric oxide was started. In each of these animals, five different nitric oxide concentrations (4 to 20 parts per million) were inhaled for 30 mins, followed by a 30-min washout period. The other three groups served as controls and received only one treatment protocol: nitric oxide (4 to 20 parts per million), or surfactant (25 mg/kg), or positive end-expiratory pressure (10 cm H2O). Measurements and Main Results: Before and after ravage, blood gases and lung mechanics were measured every 30 mins. Both strategies to increase lung aerationimproved Pao(2) values from 61 +/- 13 torr (8.1 +/- 1.7 kPa) to 200 to 300 torr (26.6 to 39.9 kPa) in 30 mins. After inhalation of nitric oxide, additional increases of oxygenation were seen only in the animals that received a low dose (25 mg/kg) of surfactant. The control groupthat inhaled nitric oxide showed no significant change in oxygenation, and four of the six animals did not survive the observation period. In the two groups in which positive end expiratory pressure was increased to 10 cm H2O, half of the animals developed a pneumothorax during the observation period. Conclusion: These data indicate that inhaled nitric oxide is able to improve arterial oxygenation after alveolar recruitment by means of a low dose of exogenous surfactant, and not by increase of positive end-expiratory pressure from 6 to 10 cm H2O, in lung-lavaged rabbits.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/07/20 alle ore 06:08:39