tailieunhanh - Báo cáo khoa học: "Bench-to-bedside review: Paediatric viral lower respiratory tract disease necessitating mechanical ventilation – should we use exogenous surfactant"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bench-to-bedside review: Paediatric viral lower respiratory tract disease necessitating mechanical ventilation – should we use exogenous surfactant? | Critical Care December 2005 Vol 9 No 6 Kneyber et al. Review Bench-to-bedside review Paediatric viral lower respiratory tract disease necessitating mechanical ventilation - should we use exogenous surfactant Martin CJ Kneyber1 Frans B Plotz1 and Jan LL Kimpen2 1 Department of Pediatric Intensive Care VU University Medical Center Amsterdam The Netherlands 2Department of Pediatrics Wilhelmina Children s Hospital Utrecht The Netherlands Corresponding author Martin CJ Kneyber Published online 5 October 2005 Critical Care 2005 9 550-555 DOI cc3823 This article is online at http content 9 6 550 2005 BioMed Central Ltd Abstract Treatment of infants with viral lower respiratory tract disease LRTD necessitating mechanical ventilation is mainly symptomatic. The therapeutic use of surfactant seems rational because significantly lower levels of surfactant phospholipids and proteins and impaired capacity to reduce surface tension were observed among infants and young children with viral LRTD. This article reviews the role of pulmonary surfactant in the pathogenesis of paediatric viral LRTD. Three randomized trials demonstrated improved oxygenation and reduced duration of mechanical ventilation and paediatric intensive care unit stay in young children with viral LRTD after administration of exogenous surfactant. This suggest that exogenous surfactant is the first beneficial treatment for ventilated infants with viral LRTD. Additionally in vitro and animal studies demonstrated that surfactant associated proteins SP-A and SP-D bind to respiratory viruses play a role in eliminating these viruses and induce an inflammatory response. Although these immunomodulating effects are promising the available data are inconclusive and the findings are unconfirmed in humans. In summary exogenous surfactant in ventilated infants with viral LRTD could be a useful therapeutic approach. Its beneficial role in improving oxygenation has already been established