TY - JOUR
T1 - Surfactant composition reflects lung overinflation and arterial oxygenation in patients with acute lung injury
AU - Bersten, A. D.
AU - Doyle, I. R.
AU - Davidson, K. G.
AU - Barr, H. A.
AU - Nicholas, T. E.
AU - Kermeen, F.
PY - 1998/8
Y1 - 1998/8
N2 - Pulmonary surfactant abnormalities have consistently been documented in patients with acute lung injury (ALI), however, there is little evidence directly correlating them to altered respiratory mechanics. To explore this further, surfactant composition was measured in lung aspirate fluid collected on 15 occasions from 10 patients with ALI. The composition was compared with lung aspirate fluid from 11 intubated patients prior to elective cardiac surgery (CS), and bronchoalveolar lavage fluid from 16 normal subjects. In both the ALl and cardiac groups the proportion of disaturated phospholipids (DSP) and phosphatidylcholine was reduced. Plasma levels of surfactant proteins-A and -B (SP-A and -B) were elevated, but were unrelated to alveolar surfactant levels. In the ALI group, and the ALI + CS group, DSP, normalized to the total phospholipid content, sphingomyelin (SPH), and urea, showed strong direct correlations with arterial oxygen tension/inspiratory oxygen fraction (all p≤0.01). In the ALI group, normalized DSP was also directly related to the elastance of the positive end-expiratory pressure-induced increase in the end-expiratory lung volume (all p<0.02), and indirect correlations were found with a measure of lung overinflation (% E2; all p≤0.01). We conclude that surfactant composition correlates with lung function abnormalities in acute lung injury and cardiac patients, and that both groups had elevated plasma surfactant proteins-A and -B levels, consistent with a concurrent increase in alveolocapillary permeability.
AB - Pulmonary surfactant abnormalities have consistently been documented in patients with acute lung injury (ALI), however, there is little evidence directly correlating them to altered respiratory mechanics. To explore this further, surfactant composition was measured in lung aspirate fluid collected on 15 occasions from 10 patients with ALI. The composition was compared with lung aspirate fluid from 11 intubated patients prior to elective cardiac surgery (CS), and bronchoalveolar lavage fluid from 16 normal subjects. In both the ALl and cardiac groups the proportion of disaturated phospholipids (DSP) and phosphatidylcholine was reduced. Plasma levels of surfactant proteins-A and -B (SP-A and -B) were elevated, but were unrelated to alveolar surfactant levels. In the ALI group, and the ALI + CS group, DSP, normalized to the total phospholipid content, sphingomyelin (SPH), and urea, showed strong direct correlations with arterial oxygen tension/inspiratory oxygen fraction (all p≤0.01). In the ALI group, normalized DSP was also directly related to the elastance of the positive end-expiratory pressure-induced increase in the end-expiratory lung volume (all p<0.02), and indirect correlations were found with a measure of lung overinflation (% E2; all p≤0.01). We conclude that surfactant composition correlates with lung function abnormalities in acute lung injury and cardiac patients, and that both groups had elevated plasma surfactant proteins-A and -B levels, consistent with a concurrent increase in alveolocapillary permeability.
KW - Acute lung injury
KW - Acute respiratory distress syndrome
KW - Lung function
KW - Respiratory mechanics
KW - Surfactant phospholipids
KW - Surfactant proteins- A and -B
UR - http://www.scopus.com/inward/record.url?scp=0031814132&partnerID=8YFLogxK
U2 - 10.1183/09031936.98.12020301
DO - 10.1183/09031936.98.12020301
M3 - Article
C2 - 9727778
AN - SCOPUS:0031814132
VL - 12
SP - 301
EP - 308
JO - The European Respiratory Journal
JF - The European Respiratory Journal
SN - 1399-3003
IS - 2
ER -