Recombinant Surfactant Protein C–based Surfactant for Patients with Severe Direct Lung Injury
| Autor: | Andreas Günther, James F. Lewis, Kenneth Krell, Roger G. Spragg, Nathan C. Dean, Peter Schenk, Andreas Karabinis, Clemens Ruppert, Friedemann J.H. Taut |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Resuscitation Time Factors Adolescent medicine.medical_treatment Acute Lung Injury Lung injury Critical Care and Intensive Care Medicine Young Adult Double-Blind Method Pulmonary surfactant Intensive care medicine Humans Child Aged Aged 80 and over Mechanical ventilation Respiratory distress Pulmonary Gas Exchange business.industry Respiratory disease Middle Aged medicine.disease Pulmonary Surfactant-Associated Protein C Respiration Artificial Recombinant Proteins Surgery Pneumonia Treatment Outcome Anesthesia Female business |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine. 183:1055-1061 |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/rccm.201009-1424oc |
| Popis: | Patients with acute lung injury have impaired function of the lung surfactant system. Prior clinical trials have shown that treatment with exogenous recombinant surfactant protein C (rSP-C)-based surfactant results in improvement in blood oxygenation and have suggested that treatment of patients with severe direct lung injury may decrease mortality.Determine the clinical benefit of administering an rSP-C-based synthetic surfactant to patients with severe direct lung injury due to pneumonia or aspiration.A prospective randomized blinded study was performed at 161 centers in 22 countries. Patients were randomly allocated to receive usual care plus up to eight doses of rSP-C surfactant administered over 96 hours (n = 419) or only usual care (n = 424).Mortality to 28 days after treatment, the requirement for mechanical ventilation, and the number of nonpulmonary organ failure-free days were not different between study groups. In contrast to prior studies, there was no improvement in oxygenation in patients receiving surfactant compared with the usual care group. Investigation of the possible reasons underlying the lack of efficacy suggested a partial inactivation of rSP-C surfactant caused by a step of the resuspension process that was introduced with this study.In this study, rSP-C-based surfactant was of no clinical benefit to patients with severe direct lung injury. The unexpected lack of improvement in oxygenation, coupled with the results of in vitro tests, suggest that the administered suspension may have had insufficient surface activity to achieve clinical benefit. |
| Databáze: | OpenAIRE |
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