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  • Title: [Surfactant-BL and inhaled nitric oxide in acute respiratory distress syndrome in cardiac surgical patients].
    Author: Kozlov IA, Poptsov VN.
    Journal: Anesteziol Reanimatol; 2005; (6):38-41. PubMed ID: 16499105.
    Abstract:
    The study was undertaken to evaluate lung function, central hemodynamics, and the oxygen transport system during combined therapy with surfactant-BL ("Biodurf", Saint Petersburg) and inhalational nitric oxide (iNO) for the acute respiratory distress syndrome (ARDS) after surgery using extracorporeal circulation (EC). Twenty-three patients (18 males and 5 females) aged 43 to 71 years (mean 56.5 +/- 2.4 years) were examined. The diagnosis of ARDS was established in accordance with the criteria recommended by the USA-European Consensus Conference on ARDS. Surfactant-BL was administered endobronchially. There were 1-3 (2.1 +/- 0.2) administrations; the first administration was made 16 +/- 4 hours after the onset of ARDS. The single dose of the agent was 2.7-4.1 (3.6 +/- 0.1) mg/kg; its course dose was 2.7-11.1 (7.9 +/- 0.9) mg/kg. Following 24 hours of the initiation of surfactant-BL therapy, there was a noticeable improvement of pulmonary oxygenizing function, a significant increase in P(a)O2 and SaO2 (p < 0.05), and a reduction in alveolar-arterial O2 differences and Qs/Qt. Thoracopulmonary compliance dynamics increased by 8.6 ml/cm H2O (p < 0.05). There was a significant rise in the O2 transport index (p < 0.05). Two days later, the magnitude of positive changes increased. The sensitivity of pulmonary oxygenizing function to iNO was enhanced by the administration of surfactant-BL. On days 3-5 days after the detection of ARDS, there was, along with the improved gas-exchange function of the lung, a significant decrease in the severity of its damage according to the Murray scale. Total mortality was 39%. Arterial hypoxemia was not a cause of death in any cases. It is concluded that the combined use of surfactant-BL and iNO ensures significantly improved pulmonary oxygenizing function, decreased thoracopulmonary compliance, and better O2 transport.
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