Bronchopulmonary segmental lavage with surfaxin (KL4-surfactant) for acute respiratory distress syndrome

被引:86
作者
Wiswell, TE
Smith, RM
Katz, LB
Mastroianni, L
Wong, DY
Willms, D
Heard, S
Wilson, M
Hite, RD
Anzueto, A
Revak, SD
Cochrane, CG
机构
[1] Discovery Labs Inc, Doylestown, PA 18901 USA
[2] Univ Calif San Diego, Div Pulm & Crit Care Med, San Diego, CA 92103 USA
[3] Sharp Mem Hosp, Div Pulmonol, San Diego, CA 92103 USA
[4] Univ Massachusetts, Med Ctr, Dept Anesthesiol, Worcester, MA USA
[5] Univ Massachusetts, Med Ctr, Div Pulm Allergy & Crit Care Med, Worcester, MA USA
[6] Wake Forest Univ, Sch Med, Pulm & Crit Care Med Sect, Winston Salem, NC 27109 USA
[7] Univ Texas, Hlth Sci Ctr, Div Pulm Dis, San Antonio, TX USA
[8] Scripps Res Inst, La Jolla, CA USA
关键词
D O I
10.1164/ajrccm.160.4.9808118
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
We performed a trial to assess the safety and tolerability of sequential bronchopulmonary segmental lavage with a dilute synthetic surfactant (Surfaxin) in 12 adults with ARDS. Patients received one of three dosing regimens in which aliquots of Surfaxin were administered via a wedged bronchoscope to each of the 19 bronchopulmonary segments. Suctioning was performed 10-30 s after Instillation of individual aliquots. Group 1 patients (n = 3) received one 30-ml aliquot of a 2.5-mg/ml concentration of Surfaxin in each segment, followed by a second 30-ml aliquot with a 10-mg/ml concentration. Group 2 patients (n = 4) received two 30-ml aliquots of the 2.5-mg/ml concentration followed by a third ravage with the 10-mg/ml concentration. Group 3 patients (n = 5) received therapy identical to that received by patients in Group 2 and were eligible for repeat dosing 6 to 24 h later. All patients tolerated the procedure. There were no serious adverse experiences ascribed to either the procedure or the surfactant. In the 96 h after treatment initiation, FIO2 decreased from 0.80 to 0.52 and PEEP decreased from 10.3 to 7.6 cm H2O. Bronchoscopic "cleansing" of the lungs with dilute Surfaxin may offer a safe and feasible approach to improving outcomes in patients with ARDS.
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收藏
页码:1188 / 1195
页数:8
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