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Titolo:
Improvement of lung mechanics by exogenous surfactant: effect of prior application of high positive end-expiratory pressure
Autore:
Hartog, A; Gommers, D; Haitsma, JJ; Lachmann, B;
Indirizzi:
Erasmus Univ, Dept Anaesthesiol, NL-3000 DR Rotterdam, Netherlands ErasmusUniv Rotterdam Netherlands NL-3000 DR DR Rotterdam, Netherlands
Titolo Testata:
BRITISH JOURNAL OF ANAESTHESIA
fascicolo: 5, volume: 85, anno: 2000,
pagine: 752 - 756
SICI:
0007-0912(200011)85:5<752:IOLMBE>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS-SYNDROME; VENTILATION; THERAPY; INJURY; MODEL;
Keywords:
models, respiratory distress; ventilation, mechanical; lung, surfactants; lung, lavage;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Lachmann, B Erasmus Univ, Dept Anaesthesiol, Room Ee 2393,Post Box 1738, NL-3000 DR Rotterdam, Netherlands Erasmus Univ Room Ee 2393,Post Box 1738 Rotterdam Netherlands NL-3000 DR
Citazione:
A. Hartog et al., "Improvement of lung mechanics by exogenous surfactant: effect of prior application of high positive end-expiratory pressure", BR J ANAEST, 85(5), 2000, pp. 752-756

Abstract

The use of a ventilation strategy with high positive end-expiratory pressure (PEEP) that is intended to recruit collapsed alveoli and to prevent recurrent collapse can reduce alveolar protein influx in experimental acute lung injury (ALI). This could affect the pulmonary response to treatment with surfactant, since plasma proteins inhibit surfactant function. We studied the effect of exogenous surfactant on lung mechanics after 4 h of mechanicalventilation with high or low PEEP. Twenty-two adult male Sprague-Dawley rats were anaesthetized, tracheotomized and submitted to pressure-controlled mechanical ventilation with 100% oxygen. One group served as healthy controls (n=6). In the remaining animals acute lung injury was induced by repeated lung lavages to obtain a Pa-O2 < 13 kPa during ventilation with a peak inspiratory pressure (PIP) of 26 cm H2O and a PEEP of 6 cm H2O. These animalswere allocated randomly to ventilation with high PEEP (n=8; 100 breaths min(-1), I:E= 1:1, PIP 35 cm H2O, PEEP 18 cm H2O) Or to conventional mechanical ventilation (PIP 28 cm H2O, PEEP 8 cm H2O; n=8; ventilated control group). After 4 h of ventilation, all animals were given surfactant (120 mg kg(-1)) via the trachea and ventilation was continued for 15 min. At the end ofthe study, pressure-volume curves were constructed to measure total lung capacity at 35 cm H2O (TLC35) and maximal compliance (C-max) and bronchoalveolar lavage was then used to measure alveolar protein influx. After ravage,Pa-O2 remained around 13 kPa in the ventilated control group and was >66 kPa in the high-PEEP group. After surfactant treatment, Pa-O2 increased to >53 kPa in both groups. In the ventilated control group alveolar protein influx was greater and TLC35 and C-max were lower than in the high-PEEP group. We conclude that the pulmonary response to exogenous surfactant after mechanical ventilation in experimental ALI is improved when a ventilation strategy with high PEEP is used.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 12/07/20 alle ore 10:27:57