Surfactant replacement for ventilator-associated pneumonia: a preliminary report.
作者信息
Baughman Robert P, Henderson Rogene F, Whitsett Jeffrey, Gunther Karen L, Keeton Deborah A, Waide James J, Zaccardelli David S, Pattishall Edward N, Rashkin Mitchell C
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0564, USA.
出版信息
Respiration. 2002;69(1):57-62. doi: 10.1159/000049371.
BACKGROUND
Surfactant abnormalities have been described in bacterial pneumonia.
OBJECTIVE
To determine the safety and effect of exogenous surfactant replacement in patients with ventilator-associated pneumonia (VAP).
METHODS
Patients with VAP were randomized in a double-blind study to receive either an artificial surfactant (Exosurf) consisting mostly of disaturated phospholipids (DSPL) or saline via a continuous nebulizer system for 5 days. Patients underwent bronchoscopy and bronchoalveolar lavage (BAL) prior to and after 4 days of therapy.
RESULTS
Twenty-two patients were randomized, with 8 receiving Exosurf. There was no detected difference in outcome between the saline- and Exosurf-treated patients in terms of days on ventilator, 30-day or hospital mortality. At the follow-up lavage, the patients treated with Exosurf had a significant rise in the level of DSPL (p < 0.05), while the saline group did not, suggesting delivery of drug. Also at the follow-up lavage, the percentage of neutrophils in the BAL fell in the Exosurf patients (p < 0.01), but not in the saline group.
CONCLUSION
Exogenous surfactant replacement given to patients with VAP increased the amount of DSPL retrieved by BAL. This treatment was associated with a fall in the neutrophil response to pneumonia.
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