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Lavage-induced Surfactant Depletion in Pigs As a Model of the Acute Respiratory Distress Syndrome (ARDS)
Published on: September 7, 2016
Terapia de reemplazo de agentes tensioactivos en la etapa tardía del síndrome de dificultad respiratoria en adultos
P L Haslam1, D A Hughes, P D MacNaughton
1Cell Biology Unit, National Heart and Lung Institute, London, UK.
Lancet (London, England)
|April 23, 1994
Resumen
El surfactante artificial ALEC mejoró los niveles de fosfolípidos pulmonares en pacientes con síndrome de dificultad respiratoria aguda (SRAP). Sin embargo, no se observaron beneficios clínicos sostenidos, lo que sugiere que se necesitan más investigaciones para un tratamiento eficaz de ARDS.
Área de la Ciencia:
- Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
- Medicina de cuidados críticos Medicina de cuidados críticos.
- La bioquímica es la bioquímica.
Sus antecedentes:
- El síndrome de dificultad respiratoria aguda (SRAP) es una afección pulmonar grave caracterizada por lesiones pulmonares e inflamación.
- La deficiencia de tensioactivo, en particular de fosfatidilcolina (PC), es un sello distintivo de ARDS, que afecta la función pulmonar.
- Las estrategias terapéuticas actuales para el ARDS tienen una eficacia limitada en la etapa tardía de la enfermedad.
Objetivo del estudio:
- Para evaluar la eficacia de una dosis única de surfactante artificial ALEC en pacientes adultos con el estadio avanzado de ARDS.
- Evaluar el impacto del tratamiento con ALEC en la composición de fosfolípidos pulmonares y la contaminación por proteínas.
- Para determinar si la administración de ALEC conduce a una mejora clínica sostenida en la ERA.
Principales métodos:
- Instilación intrabronquial de una dosis única de surfactante artificial ALEC en cuatro pacientes adultos con SDRAR en etapa avanzada.
- Se realizó lavado broncoalveolar (BAL) para medir las concentraciones de fosfolípidos (fosfatidilcolina, fosfatidilglicerol) y la contaminación de proteínas a las 24 horas después del tratamiento.
- El estado clínico y los resultados de los pacientes fueron monitoreados para una mejora sostenida.
Principales resultados:
- No se observó una mejoría clínica sostenida en los pacientes después del tratamiento con ALEC.
- Las mediciones de BAL mostraron un aumento significativo en la fosfatidilcolina (hasta 4.4 veces) y el fosfatidilglicerol (hasta 34.7 veces) a las 24 horas.
- A pesar de los aumentos, los niveles de fosfatidilcolina en relación con los fosfolípidos totales se mantuvieron por debajo de lo normal, y la contaminación por proteínas en relación con el PC se mantuvo elevada.
Conclusiones:
- Una sola dosis de surfactante artificial ALEC puede aumentar los niveles de fosfolípidos pulmonares en el estadio avanzado de la ERAP.
- Los aumentos observados en los fosfolípidos no se tradujeron en una mejora clínica sostenida.
- Se necesita más investigación sobre formulaciones terapéuticas optimizadas y regímenes de tratamiento para una suplementación efectiva de PC en ARDS.
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