Abstract
The acute respiratory distress syndrome (ARDS) is characterized by impaired ventilation-perfusion matching with severe hypoxemia [1]. In ARDS available treatments are still inadequate, and mortality and costs remain unacceptably high [1]. In the last decade, the morbidity and mortality rates of premature infants suffering from the respiratory distress syndrome have been decreased by exogenous surfactant therapy and this treatment is now routinely used in most neonatal intensive care units [2]. Surfactant abnormalities are also seen in adults with ARDS [3] . Therefore, it seems rational to administer exogenous surfactant in adults with ARDS, but the question then arises why this is not yet a reality [4]. Recently, Gregory and colleagues [5] reported that mortality could be decreased from 43.8 to 17.6% in patients with ARDS by instillation of 400 mg surfactant per kg body weight. At current prices, the cost of surfactant treatment for one adult would be above $ 75,000. This prohibitive price and the non-availability of large amounts of surfactant, make surfactant therapy not yet feasible in adults.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Bernard GR, Artigas A, Brigham KL et al (1994) The American-European consensus conference on ARDS: definitions, mechanics, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824
Jobe AH (1993) Pulmonary surfactant therapy. N Engl J Med 328:861–868
Seeger W, Günther A, Walmrath HD et al (1993) Alveolar surfactant and adult respiratory distress syndrome. Clin Investig 71:177–190
Gommers D, Lachmann B (1995) Surfactant therapy in the adult patient. Current Opinion Crit Care 1:57–61
Gregory TJ, Gadek JE, Hyers TM et al (1994) Survanta supplementation in patients with acute respiratory distress syndrome (ARDS). Am J Respir Crit Care Med 1494[Suppl7]:A567
Verbrugge S, Gommers D, Lachmann B (1995) Liquid ventilation as an alternative ventilatory support. Current Opinion Anaesthesiol 8:551–556
Lachmann B, Gommers D, Raj an NG (1996) Rationale and techniques to improve ventilation and gas exchange in acute lung injury. J Jpn Med Soc Biol Interface 26[Suppl]:115–137
Rossaint R, Falke KJ, Lopez F et al (1993) Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 328:399–405
Palmer RMJ, Ferrige AG, Moncada S (1987) Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature 327:524–526
Gommers D, Lachmann B (1993) Surfactant therapy: does it have a role in adults? Clin Intensive Care 4:284–295
Gommers D, Houmes R-JM, Olsson SG et al (1994) Exogenous surfactant and nitric oxide have a synergetic effect in improving respiratory failure. Am J Respir Crit Care Med 149 (part 2):A568
Finer NN, Etches PC, Kamstra B et al (1994) Inhaled nitric oxide in infants referred for extracorporeal membrane oxygenation: dose response. J Pediatr 124:302–308
Lachmann B, Eijking EP, So KL et al (1994) In vivo evaluation of the inhibitory capacity of human plasma on exogenous surfactant function. Intensive Care Med 20:6–11
Kinsella JP, Abman SH (1994) Efficacy of inhalational nitric oxide therapy in the clinical management of persistent pulmonary hypertension of the newborn. Chest 105:92S-94S
Karamanoukian HL, Glick PL, Wilcox DT et al (1995) Pathophysiology of congenital diaphragmatic hernia VIII: inhaled nitric oxide requires exogenous surfactant therapy in the lamb model of congenital diaphragmatic hernia. J Pediatr Surg 30:1–4
Lachmann B, Verbrugge S (1996) Liquid Ventilation. Current Opinion Crit Care 2:60–66
Gauger PG, Prakinoff T, Schreiner RJ et al (1996) Initial experience with partial liquid ventilation in pediatric patients with acute respiratory distress syndrome. Crit Care Med 24:16–22
Hirschl RB, Pranikoff T, Wise C et al (1996) Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA 275:383–389
Toro-Figueroa LO, Meliones JN, Curtis SE et al (1996) Perflubron partial liquid ventilation (PLV) in children with ARDS: A safety and efficacy pilot study. Crit Care Med 24:A150
Tütüncü AS, Faithfull NS, Lachmann B (1993) Intratracheal perfluorocarbon administration combined with artificial ventilation in experimental respiratory distress syndrome: dose-dependent improvement of gas exchange. Crit Care Med 21:962–969
Wilcox DT, Glick PL, Karamanoukian HL et al (1995) Perfluorocarbon-associated gas exchange improves pulmonary mechanics, oxygenation, ventilation, and allows nitric oxide delivery in the hypoplastic lung congenital diaphragmatic hernia lamb model. Crit Care Med 23:1858–1863
Houmes RJM, Verbrugge SJC, Lachmann B (1995) Effects of nitric oxide administration on gas exchange and hemodynamics during perflubron partial liquid ventilation during induced respiratory insufficiency. Am J Resp Crit Care Med 151:A446
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1997 Springer-Verlag Italia
About this paper
Cite this paper
Lachmann, B., Verbrugge, S., Gommers, D. (1997). Combining Exogenous Surfactant or Perfluorocarbons with Inhaled Nitric Oxide to Improve Lung Function in Acute Respiratory Failure. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2296-6_28
Download citation
DOI: https://doi.org/10.1007/978-88-470-2296-6_28
Publisher Name: Springer, Milano
Print ISBN: 978-3-540-75032-1
Online ISBN: 978-88-470-2296-6
eBook Packages: Springer Book Archive