[Surfactant-BL and inhaled nitric oxide in acute respiratory distress syndrome in cardiac surgical patients].
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.
Kozlov
I A
IA
Poptsov
V N
VN
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000502:physiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012123:Pulmonary Ventilation; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D012129:Respiratory Function Tests; D016896:Treatment Outcome
D011663:Pulmonary Surfactants; D009569:Nitric Oxide