IN-VIVO EVALUATION OF THE INHIBITORY CAPACITY OF HUMAN PLASMA ON EXOGENOUS SURFACTANT FUNCTION

被引:68
作者
LACHMANN, B
EIJKING, EP
SO, KL
GOMMERS, D
机构
[1] Department of Anesthesiology, Room Ee 2393, Erasmus University, Rotterdam, NL-3000 DR
关键词
ANIMAL MODEL; BLOOD GASES; RESPIRATORY FAILURE; EXOGENOUS SURFACTANT THERAPY; SURFACTANT INHIBITION; PLASMA PROTEINS;
D O I
10.1007/BF02425047
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: The adult respiratory distress syndrome (ARDS) and neonatal respiratory distress syndrome (RDS) are characterized by high permeability pulmonary edema which contains plasma-derived proteins inhibiting pulmonary surfactant function. Currently, discussion continues as to what dose of surfactant is required for treatment of these syndromes. Design: The purpose of this study was to investigate the amount of exogenous surfactant needed to overcome the inhibitory components in human plasma. Male adult rats suffering from respiratory failure due to surfactant depletion after whole-lung lavage received human plasma (4 ml/kg body weight) mixed with surfactant at different concentrations, intratracheally. Rats receiving surfactant only at different concentrations served as controls. Blood gas analysis was performed. Measurements and results: It was demonstrated that plasma (4 ml/kg approximate to 273 mg plasma proteins/kg) mixed with surfactant at 300 mg/kg was able to increase and maintain PaO2 normal values. Plasma mixed with surfactant at 100 mg/kg, after initial restoration of blood gases, showed deterioration of PaO2 values. Plasma mixed with surfactant at a dose of 50 mg/kg did not improve PaO2 whereas surfactant at 50 mg/kg, without plasma, restored blood gases to pre-lavage values. Conclusion: It is concluded that approximately 1 mg surfactant phospholipids is required to overcome the inhibitory effect of approximately 1 mg plasma proteins. For clinical practice this means that an excess of surfactant should be given, or repeatedly be substituted (''titrated'') at low concentrations, until blood gases improve.
引用
收藏
页码:6 / 11
页数:6
相关论文
共 54 条
  • [1] SURFACE PROPERTIES IN RELATION TO ATELECTASIS AND HYALINE MEMBRANE DISEASE
    AVERY, ME
    MEAD, J
    [J]. AMA JOURNAL OF DISEASES OF CHILDREN, 1959, 97 (05): : 517 - 523
  • [2] MECHANISMS OF DAMAGE TO LUNG SURFACTANT SYSTEM - ULTRASTRUCTURE AND QUANTITATION OF NORMAL AND IN-VITRO INACTIVATED LUNG SURFACTANT
    BALIS, JU
    SHELLEY, SA
    MCCUE, MJ
    RAPPAPORT, ES
    [J]. EXPERIMENTAL AND MOLECULAR PATHOLOGY, 1971, 14 (02) : 243 - +
  • [3] GAS-EXCHANGE AND LUNG MORPHOLOGY AFTER SURFACTANT REPLACEMENT IN EXPERIMENTAL ADULT RESPIRATORY-DISTRESS SYNDROME INDUCED BY REPEATED LUNG LAVAGE
    BERGGREN, P
    LACHMANN, B
    CURSTEDT, T
    GROSSMANN, G
    ROBERTSON, B
    [J]. ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1986, 30 (04) : 321 - 328
  • [4] BOS AP, 1991, LANCET, V337, P1217
  • [5] PULMONARY SURFACTANT-ASSOCIATED PROTEIN-A ENHANCES THE SURFACE-ACTIVITY OF LIPID EXTRACT SURFACTANT AND REVERSES INHIBITION BY BLOOD PROTEINS INVITRO
    COCKSHUTT, AM
    WEITZ, J
    POSSMAYER, F
    [J]. BIOCHEMISTRY, 1990, 29 (36) : 8424 - 8429
  • [6] DUNN MS, 1990, PEDIATRICS, V86, P564
  • [7] EFFECT OF SURFACTANT REPLACEMENT ON PNEUMOCYSTIS-CARINII PNEUMONIA IN RATS
    EIJKING, EP
    VANDAAL, GJ
    TENBRINCK, R
    LUIJENDIJK, A
    SLUITERS, JF
    HANNAPPEL, E
    LACHMANN, B
    [J]. INTENSIVE CARE MEDICINE, 1991, 17 (08) : 475 - 478
  • [8] INACTIVATION OF EXOGENOUS SURFACTANT IN EXPERIMENTAL RESPIRATORY-FAILURE INDUCED BY HYPEROXIA
    ENNEMA, JJ
    KOBAYASHI, T
    ROBERTSON, B
    CURSTEDT, T
    [J]. ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1988, 32 (08) : 665 - 671
  • [9] ARTIFICIAL PULMONARY SURFACTANT INHIBITED BY PROTEINS
    FUCHIMUKAI, T
    FUJIWARA, T
    TAKAHASHI, A
    ENHORNING, G
    [J]. JOURNAL OF APPLIED PHYSIOLOGY, 1987, 62 (02) : 429 - 437
  • [10] FUJIWARA T, 1980, LANCET, V1, P55