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Titolo:
Utility of deadspace and capnometry measurements in determination of surfactant efficacy in surfactant-depleted lungs
Autore:
Wenzel, U; Rudiger, M; Wagner, MH; Wauer, RR;
Indirizzi:
Humboldt Univ, Charite Hosp, Dept Neonatol, Berlin, Germany Humboldt UnivBerlin Germany arite Hosp, Dept Neonatol, Berlin, Germany Humboldt Univ, Virchow Hosp, Dept Neonatol, Berlin, Germany Humboldt UnivBerlin Germany rchow Hosp, Dept Neonatol, Berlin, Germany
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 5, volume: 27, anno: 1999,
pagine: 946 - 952
SICI:
0090-3493(199905)27:5<946:UODACM>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS SYNDROME; SINGLE BREATH TEST; CARBON-DIOXIDE; GAS-EXCHANGE; VENTILATION; PRESSURE; CHILDREN; INFANTS; INSTILLATION; REPLACEMENT;
Keywords:
respiratory deadspace; pulmonary gas exchange; blood gas monitoring; carbon dioxide; respiratory distress syndrome; surfactant substitution;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Wauer, RR Humboldtrmany, Fak Med, Abt Neonatol, Schumannstr 20-21, D-10098Berlin, Ge Humboldt Univ Schumannstr 20-21 Berlin Germany D-10098 rlin, Ge
Citazione:
U. Wenzel et al., "Utility of deadspace and capnometry measurements in determination of surfactant efficacy in surfactant-depleted lungs", CRIT CARE M, 27(5), 1999, pp. 946-952

Abstract

Objective: To investigate if bronchoalveolar ravage leads to increased alveolar and physiologic deadspace or a deadspace/tidal volume ratio and if surfactant replacement restores the lung to its prelavage condition. Design: Prospective, animal cohort study. Setting: An animal laboratory in a university medical center. Subjects: Seven adult rabbits receiving artificial ventilation. Methods: Our single-breath CO2 analysis station contained the following equipment: pneumotachometer Ventrak 1550, a main stream capnometer Capnogard 1265, a signal processor, and computer software. Repeated bronchoalveolar lavage was performed in seven adult rabbits to simulate acute respiratory distress syndrome. Surfactant therapy was administered after bronchoalveolar lavage induced a 20% reduction in baseline arterial P-O2. The calculated parameters of alveolar and physiologic deadspace and the deadspace/tidal volume ratio were derived from the single breath CO2 plot by Ventrak 1550 in combination with the Capnogard 1265. The arterial end-tidalP-CO2 difference, the alveolar-arterial P-O2 difference, and the arterial/alveolar P-O2 ratio were obtained by capnography and arterial blood gas analysis. Measurements of these parameters were performed before bronchoalveolar lavage, during bronchoalveolar lavage, and after surfactant application. Measurements and Main Results: The alveolar and physiologic deadspace and the deadspace/tidal volume ratio were significantly higher in lavaged animals. After application of natural surfactant, these parameters were significantly reduced but the baseline values could not be reached. Bronchoalveolarravage led to a significant fall in the arterial/alveolar P-O2 ratio, which increased after surfactant therapy. There was a negative correlation between the arterial/alveolar P-O2 ratio and the deadspace/tidal volume ratio. The alveolar and physiologic deadspace and the deadspace/tidal volume ratiocorrelated with the arterial end tidal P-CO2 difference. The best correlation was obtained between the arterial end-tidal P-CO2 difference and the alveolar deadspace/tidal volume ratio (r = 0.98). Conclusions: Bronchoalveolar lavage elevates the alveolar and physiologic deadspace and the deadspace/tidal volume ratios and is combined with a fallin the arterial/alveolar P-O2 ratio. Surfactant treatment improves the gasexchange but does not restore the lung to its prebronchoalveolar lavage condition, which indicates that the exogenous surfactant affects only partly the recruitment of the atelectatic areas.

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Documento generato il 29/03/20 alle ore 10:45:36