Chest
Clinical InvestigationsAbnormalities in Lung Elastic Properties and Surfactant Function in Adult Respiratory Distress Syndrome
Section snippets
Materials and Methods
All patients were previously healthy and fulfilled the definition of the adult respiratory distress syndrome.2 The first specimen was obtained from a transplantation donor with brain death following massive trauma. Details of this case and the surfactant abnormalities found have been reported elsewhere.1 Five additional specimens were obtained from autopsy specimens. The salient clinical details from these five cases as well as the first reported case1 are summarized in Table 1.
All lungs were
Results
Figure 1 presents the mean static deflation pressure volume curves as a percentage of the measured total lung capacity (TLC) for all ARDS lungs compared to six control lungs studied in identical fashion. Reduced compliance is present from 10 to 2 cm H2O pressure (P < 0.05). Figure 2 shows the mean static deflation pressure volume curves presented as a percentage of predicted TLC. The total lung volumes were compared with predicted values by converting the total lung volume of a single lung
Comment
Data from five additional lung specimens obtained fresh after varying intervals following the initial lung injury and the onset of ARDS appear to confirm our earlier report. Again we found abnormal PV curves as in the original study. The magnitude of the increase in surface compressibility was of similar degree in all six ARDS specimens. The statistical significance of this increased compressibility was borderline.
Surface compressibility (C), C = (1/A)dA/dγ, or its reciprocal which is surface
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Cited by (138)
What factors predispose patients to acute respiratory distress syndrome?
2019, Evidence-Based Practice of Critical CareUpdate on ARDS: Beyond the low tidal volume
2009, American Journal of the Medical SciencesCitation Excerpt :Further studies using longer periods of proning with careful patient selection in adult ARDS are needed, although worse mentioning, a recently published study of prone positioning in a pediatric population using rigidly protocolized patient management and lengthy proning (>20 hours/d) showed no effect on mortality.34 Surfactant function is impaired in patients with ARDS.35–37 Animal models showed that the use of surfactant results in improvement in the gas exchange.9,38
Pediatric intensive care: Mechanical ventilation in acute respiratory distress syndrome/acute pulmonary lesion
2008, Anales de Pediatria ContinuadaRestrictive Diseases
2008, Mechanical Ventilation: Clinical Applications and PathophysiologyAdjunctive Therapy to Mechanical Ventilation: Surfactant Therapy, Liquid Ventilation, and Prone Position
2006, Clinics in Chest MedicineCitation Excerpt :Surfactant replacement therapy has been proposed as an adjunctive and anti-inflammatory treatment in ARDS. Surfactant abnormalities were one of the first pathophysiologic abnormalities described in patients with ARDS [34–36]. Current data suggest that the pattern of ventilation may affect conversion of large functional surfactant aggregates to small minimally functional forms [37].
Diseases of Pulmonary Circulation
2006, Pediatric Critical Care
Supported by National Institutes of Health Grants HL05933, HL07055, HL17544 and HL17444.
Manuscript received June 30; revision accepted October 13.