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[Protective effect of exogenous pulmonary surfactant on pulmonary function during cardiopulmonary bypass in children]
1Department of Cardiovascular Surgery, Children's Hospital, Shanghai Medical University, Shanghai 200032.
Insights
Exogenous pulmonary surfactant (PS) improved respiratory function and reduced lung damage in children after heart surgery. This study shows PS is effective in preventing respiratory insufficiency post-cardiopulmonary bypass.
Area of Science:
- Pediatric Cardiac Surgery
- Respiratory Medicine
- Pulmonology
Background:
- Cardiopulmonary bypass (CPB) can lead to respiratory insufficiency in children.
- Pulmonary hypertension and VSD are common comorbidities in pediatric cardiac surgery patients.
- Exogenous pulmonary surfactant (PS) is a potential therapeutic agent for lung injury.
Purpose of the Study:
- To evaluate the protective effects of exogenous pulmonary surfactant (PS) on respiratory insufficiency in pediatric patients undergoing CPB.
- To assess the impact of PS on lung function, oxidative stress, and recovery time after cardiac surgery.
Main Methods:
- A randomized controlled trial involving 24 children with VSD and pulmonary hypertension undergoing CPB.
- Exogenous natural porcine PS was administered intratracheally in the PS group; saline was given to the control group.
- Lung dynamic compliance, oxygenation index, plasma MDA levels, intubation time, and lung ultrastructure were measured.
Main Results:
- The PS group demonstrated significantly higher dynamic lung compliance and lower oxygenation index post-CPB compared to controls.
- Exogenous PS significantly reduced plasma MDA levels, indicating decreased oxidative stress.
- Intubation time was markedly shorter in the PS group (8.9 hours) versus the control group (13.8 hours), with improved lung histology.
Conclusions:
- Exogenous natural PS provides a protective effect against respiratory insufficiency following CPB in pediatric patients with VSD and pulmonary hypertension.
- PS administration can improve lung function, reduce lung injury markers, and accelerate recovery after complex cardiac surgery.
- This suggests PS is a valuable therapeutic option for managing post-operative respiratory complications in this vulnerable patient population.
Objective:
To study the protective effect of exogenous pulmonary surfactant (PS) on respiratory insufficiency after cardiopulmonary bypass in children.
Methods:
24 children of VSD associated with pulmonary hypertension undergoing heart surgery with cardiopulmonary bypass(CPB) were randomly divided into two groups: control group and PS group. In the PS group, exogenous natural porcine PS 150 mg/kg was dropped into the intracheal tube before opening the chest and removing the aortic clamp. Equal amount of normal saline was given in the control group. Lung dynamic compliance and oxygenate index were measured before and after operation. The plasma molondialdehyde(MDA) concentration of the lung was analysed perioperatively with ELISA methods. The intubation time of the two groups and ultrastructure of the lung also was measured.
Results:
The dynamic compliance of the PS group was higher than that of the control group (P < 0.05), and the oxygenate index was significantly lower than that of the control group (P < 0.01) after CPB. Compared to the control group, the exogenous PS was able to markedly reduce the generation of MDA(P < 0.01). The intubation time of the PS group was 8.9 hours, much shorter than 13.8 hours of the control group(P < 0.001). The histological examination confirmed that the degree of pulmonary damage was significantly ameliorated in the PS group.
Conclusion:
Exogenous natural PS has protective effect on respiratory insufficiency after CPB in children with VSD associated with pulmonary hypertension.