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Lung mechanics and gas exchange in ventilated preterm infants during treatment of hyaline membrane disease with multiple doses of artificial surfactant (Exosurf)
Author(s) -
Pfenninger Jürg,
Aebi Christoph,
Bachrnann Denis,
Wagner Bendicht Peter
Publication year - 1992
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950140104
Subject(s) - medicine , mean airway pressure , anesthesia , airway resistance , pulmonary compliance , hyaline , peak inspiratory pressure , respiratory physiology , pulmonary surfactant , airway , respiratory system , tidal volume , pathology , physics , thermodynamics
Eight premature infants ventilated for hyaline membrane disease and enrolled in the OSIRIS surfactant trial were studied. Lung mechanics, gas exchange [Pa CO 2, arterial/alveolar P O 2ratio (a/A ratio)], and ventilator settings were determined 20 minutes before and 20 minutes after the end of Exosurf instillation, and subsequently at 12‐24 hour intervals. Respiratory system compliance (Crs) and resistance (Rrs) were measured by means of the single breath occlusion method. After surfactant instillation there were no significant immediate changes in Pa CO 2(36 vs. 37 mmHg), a/A ratio (0.23 vs. 0.20), Crs (0.32 vs. 0.31 mL/cm H 2 O/kg), and Rrs (0.11 vs. 0.16 cm H 2 O/mL/s) (pooled data of 18 measurement pairs). During the clinical course, mean a/A ratio improved significantly each time from 0.17 (time 0) to 0.29 (time 12‐13 hours), to 0.39 (time 24‐36 hours) and to 0.60 (time 48‐61 hours), although mean airway pressure was reduced substantially. Mean Crs increased significantly from 0.28 mL/cm H 2 O/kg (time 0) to 0.38 (time 12‐13 hours), to 0.37 (time 24‐38 hours), and to 0.52 (time 48‐61 hours), whereas mean Rrs increased from 0.10 cm H,O/mL/s (time 0) to 0.11 (time 12‐13 hours), to 0.13 (time 24‐36 hours) and to (time 48‐61 hours) with no overall significance. A highly significant correlation was found between Crs and a/A ratio (r=0.698, P < 0.001). We conclude that Exosurf does not induce immediate changes in oxygenation as does the instillation of (modified) natural surfactant preparations. However, after 12 and 24 hours of treatment oxygenation and Crs improve significantly. In contrast to other reports on dynamic compliance and gas exchange, we have been able to demonstrate an excellent correlation between oxygenation and Crs, determined by the single breath occlusion method. © 1992 Wiley‐Liss, Inc.