Gf. Zhu et al., COMBINED SURFACTANT THERAPY AND INHALED NITRIC-OXIDE IN RABBITS WITH OLEIC ACID-INDUCED ACUTE RESPIRATORY-DISTRESS SYNDROME, American journal of respiratory and critical care medicine, 158(2), 1998, pp. 437-443
Citations number
34
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
Intratracheal administration of surfactant and inhaled nitric oxide (I
NO) have had variable effects in clinical trials on patients with acut
e respiratory distress syndrome (ARDS). We hypothesized that combined
treatment with exogenous surfactant and INO may have effects in experi
mental ARDS. After intravenous infusion of oleic acid in adult rabbits
and 4-6 h of ventilation, there was more thana 40% reduction in both
dynamic compliance (Cdyn) of the respiratory system and functional res
idual capacity (FRC), a 50% increment of respiratory resistance (Rrs),
a 70% reduction in Pa-O2/FIO2 and an increase in intrapulmonary shunt
ing ((Q) over dot s/(Q) over dot T) from 4.4 to 33.5%. The animals wer
e then allocated to groups receiving (1) neither surfactant nor INO (c
ontrol), (2) 100 mg/kg of surfactant (5) administered intratracheally,
(3) 20 ppm INO (NO), or (4) 100 mg/kg of surfactant and 20 ppm INO (S
NO), and subsequently ventilated for 6 h. After the period of ventilat
ion, the animal lungs were used for analysis of disaturated phosphatid
ylcholine (DSPC) and total proteins (TP) in bronchoalveolar lavage flu
id (BALF), and for determination of alveolar volume density (Vv). The
animals in the control group had the lowest survival rate, and no impr
ovement in lung mechanics and blood oxygenation, whereas those In the
S group had a modest but statistically significant improvement in Cdyn
, Rrs, Pa-O2 and FRC, reduced (Q) over dot s/(Q) over dot T, lowered m
inimum surface tension (gamma(min)) of BALF, and increased DSPC/TP and
alveolar Vv. The NO group had increased Pa-O2 and reduced (Q) over do
ts/(Q) over dot T. The SNO group showed improved Cdyn, Rrs, FRC, DSPC/
TP, alveolar Vv, and gamma(min) of PALE comparable to the S group, but
there was a further increase in survival rate and Pa-O2, and addition
al reduction in (Q) over dot s/(Q) over dot T and TP in BALF. These re
sults indicate that, in this animal model of ARDS, a combination of su
rfactant therapy and INO is more effective than either treatment alone
.