Surfactant composition reflects lung overinflation and arterial oxygenation in patients with acute lung injury

被引:17
作者
Bersten, AD
Doyle, IR
Davidson, KG
Barr, HA
Nicholas, TE
Kermeen, F
机构
[1] Flinders Univ S Australia, Sch Med, Dept Crit Care Med, Adelaide, SA 5001, Australia
[2] Flinders Univ S Australia, Sch Med, Dept Human Physiol, Adelaide, SA 5001, Australia
关键词
acute lung injury; acute respiratory distress syndrome; lung function; respiratory mechanics; surfactant phospholipids; surfactant proteins-A and -B;
D O I
10.1183/09031936.98.12020301
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Pulmonary surfactant abnormalities have consistently been documented in patients with acute lung injury (ALI), however, there is little evidence directly correlating them to altered respiratory mechanics. To explore this further, surfactant composition was measured in lung aspirate fluid collected on 15 occasions from 10 patients with ALI, The composition was compared with lung aspirate fluid from 11 intubated patients prior to elective cardiac surgery (CS), and bronchoalveolar lavage fluid from 16 normal subjects, In both the ALI and cardiac groups the proportion of disaturated phospholipids (DSP) and phosphatidylcholine was reduced. Plasma levels of surfactant proteins-A and -B (SP-A and -B) were elevated, but were unrelated to alveolar surfactant levels. In the ALI group, and the ALI + CS group, DSP, normalized to the total phospholipid content, sphingomyelin (SPH), and urea, showed strong direct correlations with arterial oxygen tension/inspiratory oxygen fraction (all p less than or equal to 0.01). In the ALI group, normalized DSP was also directly related to the elastance of the positive end-expiratory pressure-induced increase in the end-expiratory lung volume (all p less than or equal to 0.02), and indirect correlations were found with a measure of lung overinflation (%E-2; all p less than or equal to 0.01). We conclude that surfactant composition correlates with lung function abnormalities in acute lung injury and cardiac patients, and that both groups had elevated plasma surfactant proteins-ii and -B levels, consistent with a concurrent increase in alveolocapillary permeability.
引用
收藏
页码:301 / 308
页数:8
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