Beneficial effect of exogenous pulmonary surfactant in infants suffering acute respiratory distress syndrome after cardiac surgery
10.3760/cma.j.issn.1673-4912.2019.01.010
- VernacularTitle:外源性肺泡表面活性物质对婴儿心脏手术后急性呼吸窘迫综合征的疗效
- Author:
Jiming CAI
1
;
Zhuoming XU
;
Jihong HUANG
;
Haibo ZHANG
;
Zhihao LI
Author Information
1. 上海交通大学医学院附属上海儿童医学中心心胸外科 200127
- Keywords:
Exogenous pulmonary surfactant;
Infants;
Cardiopulmonary bypass;
Acute respira-tory distress syndrome
- From:
Chinese Pediatric Emergency Medicine
2019;26(1):42-45
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore whether using of exogenous pulmonary surfactant( PS) can im-prove recovery of infants suffering postoperative acute respiratory distress syndrome after cardiac surgery and whether kinetic analysis of pulmonary functional change can be helpful to indicate an appropriate dosing scheme. Methods Nineteen infants received an exogenous PS( Curosurf,100 mg/kg,treatment group) due to acute respiratory distress syndrome after cardiac surgery for congenital heart defects. They were compared with 24 patients without its administration despite the same postoperative complication( control group) . Oxy-genation index( OI) and ventilation index( VI) were calculated and fitted with a monoexponential function be-fore and after its use. Other outcomes including chest radiography,duration of mechanical ventilation,inten-sive care unit and hospitalization were also analyzed. Results All infants who received PS survived,whereas three infants in the control group died. The duration of mechanical ventilation and hospitalization were signifi-cantly shorter after PS administration[(21. 3 ± 9. 2) d vs. (31. 1 ± 13. 4) d,t=6. 520,P=0. 004;(30. 2 ± 13. 2)d vs. (41. 3 ± 16. 5)d,t=2. 185,P=0. 03]. The infants received either one (13 cases,subgroup A) or two doses (6 cases,subgroup B) before successful weaning from the ventilator. After the first dose was ad-ministered,the maximal rates of OI and VI change were significantly higher of infants in the subgroup A[OI:(2. 9 ±1. 7) vs. (1. 0 ± 0. 8),t =3. 012,P =0. 02;VI:(16. 6 ± 9. 6) vs. (5. 8 ± 5. 6),t =2. 980,P =0. 02]. Twelve hours after the first dose,both parameters in the subgroup B deteriorated and a second dose was administered 24 h later. Conclusion Exogenous PS is an efficient medication for infants suffering acute respiratory distress syndrome after cardiac surgery. Kinetics analysis of functional change after initial surfac-tant use may be referred for early determination of an optimal dosing scheme.
