A method of treating respiratory failure in critically ill children

 

(57) Abstract:

The invention relates to medicine, more specifically to anesthesiology and critical care medicine, and may find use for the treatment of respiratory insufficiency II-III severity. The method of artificial ventilation of lungs with more endobronchial infusion of pulmonary surfactant "Surfactant-BL" or "Surfactant-HL". The surfactant is injected from the first hours of development of respiratory failure first bolus dose of 300-400 mg/m2and then in the form of an aerosol continuously for 1-3 days in the amount of 20-30 mg/h, after which the patient extabit. The method provides the possibility of early mitigation of ventilation parameters, reducing the time a patient on a ventilator until 8-72 h, a significant reduction in the total course dose of surfactant and a significant increase in the survival rate of patients. table 1.

The invention relates to medicine, more specifically to anesthesiology and critical care medicine, and may find application in the treatment of respiratory failure (NAM) II-III severity.

The present invention relates to the treatment of critical conditions in children, Central manifestation of which is the NAM II-III severity, preimuschestvami lesions.

Under critical conditions in children involve the syndrome of acute lung injury (SAP) and its extreme severity option - respiratory distress syndrome in adults (rdsw), and severe bilateral pneumonia. This NAM II-III degree is characterized by the fact that the patient [1, 2, 3]

develops hypoxemia refractory to oxygen therapy. In this patient, who is on artificial lung ventilation (ALV), oxygenation index (OI) for SOLP below 300 mm RT.art., and when rdsw below 200 mm RT.article (norm 360 - 400 mm RT.cent.). IO is the ratio of the values PaO2(pressure of oxygen in arterial blood in mm RT.CT.) it is FiO2(in relative units from 0,21 to 1.0, which corresponds to the limits of the oxygen concentration in inhaled air-gas mixtures from 21% to air% to 100%). Thus IO = PaO2/FiO2,

found bilateral infiltrative changes on the radiograph of the lungs,

develops shunting blood (venous blood passes through parts of the lungs, without aeration, and may in this form to arterial blood,

reduced lung compliance and lung volumes.

All these symptoms develops in Otsa clinic that is, when the above-described symptoms, is the value of the jamming pressure in the pulmonary artery, which must be less than 18 mm RT.article. [1, 2, 3].

SAP and rdsw occur in 1% of children hospitalized in the intensive care unit and intensive care [4].

The most common causes of the development of SAP and rdsw are severe bilateral pneumonia, sepsis and severe concomitant injury, such as a car, and various toxic conditions, in particular the inhalation of toxic substances. The development of SAP and rdsw may occur due to direct damage to the lung parenchyma (pneumonia, aspiration of gastric contents, inhalation of hot steam or air, toxic powders, liquids and gases, lung contusion) or systemic damage to the body (sepsis, concomitant injury, traumatic shock, embarrassment syndrome, prolonged mechanical ventilation, complications after cardiac operations with the use of artificial blood circulation, post-transfusion and reperfusion syndromes) [3, 4, 5].

Mortality from acute respiratory failure and rdsw in children is extremely high and depends on the background (reasons), for which it develops. In cf the>/P>Currently the mainstay of treatment of such patients is artificial lung ventilation (ALV) along with antishock, detoxification, antibiotic therapy, as well as activities aimed at maintaining fluid and electrolyte balance. IVL, usually used with "hard" parameters, i.e., a high partial pressure of oxygen in the inhaled gas mixture (FiO2, 0,8-1,0), high peak pressure breathing (more than 25-35 cm H2O), large amounts of supplied gas mixture (12-15 ml/kg body weight) and required positive pressure at the end of the expiratory (peep) [8,9].

These so-called "hard", the parameters of mechanical ventilation are more powerful damaging factors for flow NOZZLES and rdsw and often worsen the position of the patient. At the present time recommend to move away from these hard settings and apply ventilation control pressure (not by volume), it is possible to use a smaller (not more than 80%) the concentration of oxygen in the inhaled gas mixture, a lower peak pressure during inhalation (no more than 30 cm H2O) and lower (5-8 ml/kg) volume supplied to the lungs [7, 8]. However, there is a contradiction between the need to use "soft" modes of mechanical ventilation and the inherent SOLP and rdsw refractor is - and needs to overcome the use of "hard" settings IVL.

During the last 5 - 7 years in the treatment of respiratory failure in critically ill children in addition to mechanical ventilation are trying to use the pulmonary surfactant preparations that have proven successful in the treatment of RDS in newborns [3].

Known synthetic (Exosurf, Glaxo-Wellcome, USA - UK; ALEK, Britanica, UK), semisynthetic (Surfactant-TA, Tokyo Tanabe, Tokyo, Japan; Survanta, Ross/Abbott Lab, Chicago, USA) and natural preparations of pulmonary surfactant (Curosurf, Chiesi Farmaceutici, Farma, Italy; Alveofact, Thome GmbH, Biberach, Germany; Infasurf, Forrest Labs, St. Louis, USA; CLSE, Rochester, NY, USA; Surfactant-HL [10] and Surfactant-BL [11].

Drugs Surfactant-HL and Surfactant-BL developed at the Central research radiology Institute of the RF Ministry of health (cnrri MOH), S. - Petersburg. Surfactant-HL permitted for medical use by a Decision of the Pharmacological Committee (FC) RF Ministry of health (Protocol N3 from 15.04.99). Surfactant-BL approved for clinical testing in RDS infants (Protocol FC MH RF N14 from 26.09.96) and RDS adults (Protocol FC MH RF N 5 from 28.08.98). State Pharmacopoeia Committee in 1998 approved VFS on Surfactant-BL (N 42-3120-98). Clinical trials of Surfactant-BL successfully pass in 12 institutions who were receiving treatment with this drug, and more than 40 adults and younger and older age. By the end of 1999, these tests must be completed and the reports of the clinics will be presented in the Pharmacological Committee of the health Ministry to permit the medical use of Surfactant-BL. Currently in cnerry MOH created the basis for the production of drugs pulmonary surfactants with a capacity of 30 thousand bottles a year, and it will also allow the introduction of drugs in the healthcare practice for the treatment of critical conditions in newborns and adults.

Some of the main characteristics of these products are given in table. 1.[10, 11, 12].

There is a method of treatment of respiratory failure in adults in critical States (rdsw) by IVL (and all relevant to the patient's condition standard therapy) and additional infusion of synthetic drug surfactant "Exosurf" [13] . The authors report on the treatment of 725 patients (364 received treatment with a surfactant, and 361 in the control group on standard treatment who received placebo (0,45% NaCl) without surfactant). The authors used the aerosol route of administration, and the drug was administered to patients not earlier than 48 hours after clinical and laboratory diagnosis rdsw, continuously for 5 days in total dose 3240 mg on all the parameters of the ventilator, no patient survival compared with the control group. The time spent by patients on mechanical ventilation was similar in both groups and amounted to 16.4 0.9 days in the control (K) group and 16.0 1.0 days in the group treated with Exosurf. The time spent by patients in the intensive therapy was 16.7 0.8 in To and 18.1 1.1 days in the group treated with Exosurf. In both groups the incidence of complications and side effects was similar and only the frequency increased secretory activity in patients treated with Exosurf, was significantly greater than K. the Frequency of barotrauma was 11%, including pneumothorax, pneumoperitoneum, pneumopericardium and pneumocele. The study did not have children.

There is a method of treatment rdsw adults by mechanical ventilation and supplemental drug "Exosurf" [14]. The authors reported the treatment of 51 patients (34 patients received treatment with a surfactant, and 17 patients in the control group who were on standard treatment and treated with placebo (0.6% of NaCl without surfactant). Used aerosol route of administration, and Exosurf was introduced not earlier than the second day from the development of signs of respiratory distress, continuously for 5 days at 12 hours per day with a total dose of 8.4 to 9.0 g per course, or for 24 hours in total before. the reliable differences in survival, as in the previous work, was not found.

There is a method of treatment rdsw adults by mechanical ventilation and supplemental semi-synthetic preparation of surfactant "Survanta" [15]. The authors reported the treatment of 59 patients with this drug and used it through the endotracheal tube, not earlier than the second day from the development of symptoms of respiratory distress. Studied several variants of surfactant therapy (ART therapy). The first group of patients the drug was administered at a dose of 400 mg/kg in 4 separate treatment period (for a total of 32 g per course). The second group, the drug was administered at a dose of 800 mg/kg in the form of 8 doses (a total of 64 g for the entire course). They found a trend towards reduced mortality. In the group of patients who received surfactant and a dose of 400 mg/kg, mortality decreased from 44% to 18%, and received the drug at a dose of 800 mg/kg from 44% to 21%. These estimates of mortality (survival) was carried out after 120 hours (5 days) after the start of treatment rdsw. About the future and the time spent with these patients on a ventilator is not reported.

The main disadvantages of the above methods of treatment rdsw are low survival of patients, and in the case of synthetic drugs - no the owner with the "hard" settings, and the extremely high consumption of drugs surfactant.

With regard to the treatment of DN under critical conditions in children, we know only a few publications about individual cases of application of preparations of pulmonary surfactant.

Known case of treatment of 5-month-old child with DD, which developed as a result of bleeding in the right lung after surgical operations [16]. The child was on a ventilator with a "hard" parameters: Ppeak- pressure on the inhale was equal 27-31 see aq.art., IO (PO2/FiO2) - 60 - 230 mm RT.article (norm 360 - 420). The child was introduced selectively endobronhialno using a bronchoscope into the right bronchus 120 mg drug Surfactant-TA. After 30 min after the introduction of IO increased to 413, has been reduced pressure during inhalation to 25 cm aq.article and IO continued to increase after 6 hours at stable settings IVL has significantly improved the airiness of the lungs on chest x-ray. However, due to the increase in septic phenomena, the development of multiple organ failure, including renal and hepatic insufficiency, disorders in blood coagulation system and the Central nervous system the baby died at 10 days after surgery.

Known treatment of 9-year-old child in late stage development rdsw [17]. On the 17th day nahozdeniya drug ALEC. The authors have not registered improvement in oxygenation and changes in other pulmonary functions. The baby died.

Known treatment of 3-week-old child with severe DN (rdsw) [18]. The child was on a ventilator with a "hard" settings (huge pressure on the breath - 58 -62 cm aq.art., FiO2to 1.0, while the saturation of hemoglobin with oxygen (Sat) does not exceed 92 - 94% (norm 98 -100%). The child along with all the necessary therapy was introduced drug surfactant Exosurf at a dose of 270 mg 4 hours after administration was able to reduce FiO2to 0.4, while the Sat has reached 100%. After 40 hours after the introduction of the ARTICLE the child was excubitor and after 6 days was discharged home.

Closest to the present invention is a method of treatment rdsw children by mechanical ventilation and supplemental natural drug of surfactant "Infasurf", we adopted as a prototype [19]. The authors reported the treatment of 29 children aged 1 month. up to 16 years of age with respiratory failure in critical States (SOLP and rdsw, severe bilateral pneumonia). The authors used from 1 to 4 doses of surfactant in 2800 mg/m2i.e. used from 2800 to 11200 mg/m2on the course, according to the children 13 - 16 years and 1.7 times higher, i.e. up to 20 g per course. The average age of patients was 4.7 1.7 years (ostecenje 10-15 minutes and only one patient the drug was administered during the first days of the development of DN, 12 hours after the patient on a ventilator. The remaining 28 patients the drug was administered in 2 to 71 days spent on a ventilator, on average, through 17,25 days. The authors noted rapid improvement in oxygenation in 24 of the 29 patients (83%), with a resulting improvement of IO. 7 patients were ectobiology 48 hours after application of the surfactant. The time spent on a ventilator after starting ART therapy in surviving patients ranged from 2 to 13 days or an average of 4.42 day hours. In three patients there arose a severe complication in the course of the disease "syndrome air leaks", and the two of them this complication was directly related to drug use. Two patients after a single dose of surfactant in connection with the subsequent deterioration were transferred extracorporeal membrane oxygenation (ecmo). Five of the surviving patients were discharged home on oxygen support. Died 4 patients (14%).

Thus, the method-prototype as well as analogues characterized by high child mortality, prolonged presence of a child on a ventilator (up to 13 days) with a very large consumption of the drug (up to 20 g).

The technical result of the present invention is to improve child survival, reducing time nahay the introduction of the drug.

This result is achieved by the fact that pulmonary surfactant is injected from the first hours of development of respiratory failure first bolus dose of 300 - 400 mg/m2and then in the form of an aerosol continuously through the nebulizer, within 1 to 3 days in the amount of 20 - 30 mg/hour, after which the patient extabit.

It is advisable to use natural pulmonary surfactant containing phospholipids 89 - 93.8% of neutral lipids from 4.2 to 9% and surfactant-associated proteins 2%.

Doing professionally for the treatment of severe respiratory insufficiency II-III severity in children suffering from severe pneumonia, traditional methods (oxygen therapy in ventilation control volume or pressure, antibiotic therapy, the use of inotropes to stabilize hemodynamics), and in the last two years with the use of additional drugs pulmonary surfactants (Surfactant-HL and Surfactant-BL), assigning them once or within 2 to 3 days in the form of a bolus instillation or mikrostruyno, we noted a more rapid improvement in oxygenation in children receiving pulmonary surfactants.

This fact has motivated us to conduct special surveillance of the disease in different modes ST-terapii 4-6 hours a day for 1 - 3 days. When you type the amount of surfactant was 10-15 mg/kg

Receiving in most cases, the positive results of this treatment regimen, we attempted to use it in the treatment of very severe children with rdsw.

Taking into account obtained in the known methods unsatisfactory results, we tried to start ART therapy from the first day, and then hours from the appearance of persistent signs of respiratory distress.

After receiving the first impressive result of the stabilization of very heavy baby against septic shock developed rdsw, in the form of increase of IO from 55 to 180 mm RT.article (norm 360 - 420) from bolus Surfactant-BL (400 mg/m2we have continued to him the introduction of the drug aerosol at a dose of 30 mg/hour and within 36 hours the child was removed from the critical state and excubitor. During this inhalation sequentially, starting with 60 minutes from the beginning of ART-therapy, we reduced the hardness parameters IVL: FiO2from 1.0 to 0.5 and then to 0.3. In the last 24 hours of ART therapy, the child was already on a ventilator.

For treatment we used Surfactant-BL obtained from the lung of large rohatgi was administered 60 mg/hour continuously.

A positive result encouraged us to continue the research to determine the optimal modes of ART-therapy rdsw.

Our proposed scheme is the use of surfactant was found empirically.

The introduction of the first surfactant bolus in a sufficiently large dose (300 mg/m2400 mg/m2quickly, but for a short time to compensate for the deficiency of pulmonary surfactant, and thereby prevent further lung damage.

Following the introduction of ART in the form of aerosol (via nebulizer) provides a uniform distribution of surfactant in the alveolar surface of the lungs due to the homogeneous structure of the population of particles (droplets) of the surfactant amount is not more than 5 μm, formed by the nebulizer, which, in our opinion, is very important for sorption on it toxic components, their inhibition and excretion [20]. The latter leads to the normalization of the functional state of the lung parenchyma.

The introduction of the first surfactant bolus (or mikrostruyno) intratrahealno or endobronhialno using a bronchoscope (separately into the left and right main bronchi), and then in the form of an aerosol within 1 - 3 days continuously in the amount of 20 - 30 mg/kg Obasi case of respiratory failure in critically ill children.

The introduction of surfactant in the amount of 300 to 400 mg/m2(bolus or mikrostruyno), and then in a spray rate of 20 - 30 mg/h corresponds to the number of from 1.0 to 3.0 g of surfactant treatment, which is considerably less than in the known methods, characterized by the tendency to increase patient survival. This is very important considering the high cost of drugs surfactant.

Our proposed scheme is the introduction of surfactant allows exuberate patient immediately after edema respiratory failure. Moreover, the use of surfactant on the proposed method allows the first hours of the injection of the surfactant to mitigate the parameters of mechanical ventilation (FiO2PVD- pressure on the inhale, and the amount of supplied gas mixture), and thus further eliminate damaging (lung tissue) factors IVL.

The use of a preparation containing, as said above, 2.0% of the surfactant-associated proteins, is in our opinion a very important component of the proposed method. Such proteins are absent in synthetic drugs surfactant (Exosurf) is contained in an amount of 0.1% in semi-synthetic drugs (Survanta) and 1.0 - 1.5% in natural (Alveofact, Infasurf and CLSE) (see tab. 1).

1. at the phase boundary (the surface of the alveoli - air), while synthetic drugs, including Exosurf, do not contain these proteins. The reduction of surface tension on the surface of lung alveoli, carried out by phospholipids in cooperation with surfactant-associated proteins, facilitates the process of disclosure of the alveoli during inspiration, thus reducing the necessary effort chest muscles [21].

2. These proteins bind antibacterial and antiviral activity of surfactants, the ability of these proteins to be active of chemoatractant in relation to alveolar macrophages, stimulate the complement-dependent and antibody-dependent capture of pathogenic bacteria and viruses alveolar macrophages, and so on [22].

3. They also inhibit in vitro the ability of polymorphonuclear leukocytes and alveolar macrophages to excretion (release) cytokines - molecular components of proinflammatory cascade. The last damage alveolararterial membrane is the basic structural and functional element of pulmonary gas exchange [23].

The method consists in the following.

Sick child clinic with severe respiratory failure, which is on a ventilator and requires Pris syndrome bolus or mikrostruyno (intratrahealno or through the bronchoscope separately in the left and right main bronchi) injected surfactant (Surfactant-HL or Surfactant-BL) at a dose of 300 - 400 mg/m2and then, after 30 - 60 minutes hold constant inhalation of these products with the help of a nebulizer, is included in the circuit of breath the ventilator, the rate of gas flow through the nebulizer are selected on the basis of inhalation 20-30 mg of the drug per hour. Use the standard dilution of surfactant - 75 mg in 10.0 ml of physiological solution for aerosol administration. Every day perform radiographic examination of lungs, at least four times per day - the analysis of the gas composition of arterial blood and increase the oxygen tension in arterial blood (PaO2) more than 80 - 90% gradually reduce hardness parameters of mechanical ventilation. Inhalation of the drug is stopped after increasing oxygenation index up to 350-400 mm RT.article and improve the x-ray pictures.

The essence of the method is illustrated by the following examples.

Example 1.

Baby K. N East. disease 5933. Enrolled in the children's infectious diseases hospital N5 (DEEB N5) , S.-Petersburg 27.07.98 for ambulance assistance with a diagnosis of intestinal obstruction. The state of admission heavy, due to the intoxication syndrome, hypotonic dehydration of 1 degree.

Diagnosis: Ileo-colonic intussusception. Operation: dezinformatsia, reognise: rdsv, sunto-diffusion respiratory failure (NAM) - III.

After surgery, a serious condition caused by intoxication syndrome, paresis of the intestine of 2 degrees, extubate compensated. 28.07.98 during the day deterioration due to the growth characteristics of NAM, a progressive reduction in the partial pressure of oxygen in arterial blood (PaO2) 86-64-44 at independent breathing ambient air (t = 210). On the chest x-ray at 13:00 restructurant roots of the lungs, diffuse infiltrates on both sides, clinically rise breathlessness to 36 per minute. Vomiting with stagnant content, stop breathing, drop in blood pressure to 70/40. Patient santourian and placed on a ventilator with a control pressure, FiO2= 1,0 hypoxemia PaO2- 55 mm RT.article (IO = 55). Diagnosis RSD. 15:00 28.07.98 produced bolus instillation introduction of Surfactant-BL at a dose of 400 mg (400 mg/m2and within one hour after instillation managed to reduce FiO2to 0.5. At this time kept constant introduction of surfactant in the form of an aerosol using a nebulizer at a dose of 30 mg/hour and 36 hours signs of respiratory distress had disappeared completely (IO = 380, FiO2= 0,21) when restoring the hcpa is n from the ICU to the surgical. Only child received 1480 mg of Surfactant-BL on the course of therapy and was on a ventilator in the process of ART therapy 36 hours. He was discharged 12 days after suffering the WFD.

Example 2.

Child x, N East. disease 6836, age 2 months. Entered DEEB N5 S. Petersburg 06.11.97 intensive care transport, CRH, Tosno. From the anamnesis: sick with 31.10.97 (cough, runny nose, anxiety, raising the temperature to febrile digits were treated with symptomatic drugs). With 03.11.97 deterioration: refusal to eat, expressed concern that the emergence and increasing shortness of breath, cyanosis; hospitalized in CRH in the intensive care unit in critical condition due to the DN-III. Since admission to the IVL device "Mlala, therapy: antibiotics (penicillin, gentamicin, claforan), corticosteroids (5 mg/day), plasma, blood transfusion.

At admission to the intensive care unit DEEB N5 in a critical condition, DN-III century , the intoxication syndrome associated with impaired metabolism. Objective: the level of consciousness is difficult to estimate due to medical sedately. The skin is pale with a grayish tint, moderate acrocyanosis, muffled heart sounds, rhythmic, heart rate reduced the IME volume ventilation FiO2= 1,0 (Sat. 78-80%), severe hypoxemia PaO228 mm RT.article (IO = 28, at a rate of 360 - 400). In the lungs the breath in the upper sections sharply weakened over all the departments of a large number of different-sized moist rales. On the roentgenogram of lungs drain krupnouzlovaya pneumonic infiltration of the left and right in the middle and upper sections, the upper lobe atelectasis on the right. Interpretation: the child moves bacterial infection with lesions of the respiratory tract accompanied by intoxication and DN-III senior mixed (restrictive, sunto-diffusion) character (rdsw). We cannot exclude the brain of hypoxic Genesis. Prescribed treatment: dopamine at a dose of 2.5 mg/kg/min, antibiotics, claforan, gentamicin age, dosage, infusion therapy in the volume of physiological needs, IVL mode volume ventilation.

2 hours after the receipt and examination under conditions of mechanical ventilation endobronhialno mikrostruyno introduced 150 mg (300 mg/m2) Surfactant-HL and 30 minutes after this started the constant inhalation of the aerosol administration of the drug at 20 mg/hour. 2 hours after the start of a drug PaO2increased from 28 to 57 mm RT. Art. when FiO2= 1,0, after 6 hours, the reduced FiO2to 0.8. After 12 hours managed to reduce FiO2to 0.6 when PaO2= 96 mm RT.article (T = 160 mm RT. Art.). Inhalation of the drug continued next 72 hours due to the heavy state of the child at a relatively stable parameters, blood gases. After 62 hours from the beginning of the ARTICLE therapy was able to reduce the oxygen concentration in the feed gas mixture to non-toxic (FiO2to 0.4) and PaO2it was stable and equal to 96 mm RT. Art. (IO=240 mm RT. Art.). In the next 10 hours ART therapy has been a further improvement in the status and blood gases (IO= 340), radiographically recorded a significant improvement, the introduction of the surfactant and the child was excubitor. After 3 days she was transferred to the somatic compartment. Upon further observation and examination is not confirmed congenital heart disease. The increase of the boundaries of the heart during the acute phase of this severe bilateral pneumonia, which was regarded as signs of a birth defect was caused by a toxic condition and with its elimination of heart size returned to normal. Child received 150 mg of Surfactant-HL mikrostruyno and within 72 hours even 1440 mg (throughout the course 1590 mg). She was on a ventilator in the process of ART therapy in just 72 hours, on the 22nd day and 10760, enrolled in the intensive care unit DEEB N5, S. - Petersburg 29.12.98. in 19:35. Diagnosis clinical: acute inhalation poisoning by opiates, opiate coma, bilateral bronchopneumonia, DN-II, SAP.

History: according to the boy breathed in through the nose crushed to a powder, tablet, presumably mixed with powder glucose. In the analysis of urine from 29.12.98 discovered morphine.

29.12.98 the State of admission heavy due to neurological symptoms - opiate coma I degree with an estimate of the scale Glasgow 10 - 11 points, DN-I century, the saturation of hemoglobin with oxygen (Sat) when breathing room air for 80% (normal 98-100%), transferred on a ventilator when FiO2= 0,5, PaO2= 62,8 mm RT. Art. (IO = 125,6), the Sat has increased to 96%. Treatment is symptomatic.

Deterioration to 01: 00 30.12.98. progressive respiratory failure, reduction of Sat to 92%, PaO2= 68 mm RT. Art. when FiO2or = 0.6 (SD = 113), shortness of breath 36-38 in minutes, tachycardia - 120 - 130 min, fever 38,8 - 39,0oC. On the chest x-ray from 30.12.98 10:00 inhomogeneous infiltration of the upper lobe of the right lung with the presence Atlanticheskogo component, focal pneumonic changes in the lower lobes of both lungs, diagnosed Galatia medication via nebulizer at a dose of 30 mg/hour. After 6 hours after the start of ART therapy showed a significant improvement: PaO2= 112 mm RT. Art. and therefore FiO2was reduced to 0.4 (t = 230) and the boy was transferred on a ventilator. 24 hours after inhalation of the drug in the same dose (30 mg/hour) has been a significant improvement, DN disappeared, PaO2= 86 mm RT. Art. when breathing ambient air (t = 410), radiologically significant improvement and patient excubitor, 02.01.99 translated into somatic compartment. 12.01.99 was discharged from the hospital in satisfactory condition. All patient received 1320 mg of Surfactant-L.

To date, the proposed method, the treatment of 13 children with respiratory failure in critical States. All 13 patients with respiratory insufficiency was treated for 8 to 72 hours. Killed one girl 13 years from swelling of the brain and symptoms of herniation before surgery to 10 days after leaving RSD from extrapulmonary causes. Development rdsw she had and communication with direct lung damage (drowning in fresh water), the girl came and emergency Department with signs of irreversible damage to the cerebral cortex.

The proposed method is compared with the known has a number of significant reindoctrinate reached us in all patients, while in the method prototype in 24 patients out of 29. The survival rate of our patients was 12 out of 13 treated (92,3%), and in the method-prototype 24 of 29 (82,1%).

2. The method can significantly reduce the time spent by the patient on a "hard" settings, the ventilator to 2 to 12 hours and the total duration from 24 to 72 hours; i.e. provides rapid elimination of iatrogenic (physician) factors lung damage, as well as factors of damage associated with over rdsw that is very important for the prevention of fibrosis of the lung is the most frequent complications in surviving patients. It should be noted that in the method-prototype taking a child on a ventilator after the end of the ARTICLE therapy ranges from 12 hours to 13 days, and in addition 5 children were discharged from hospital accompanied by oxygen support, i.e. respiratory failure has not been stopped completely.

3. The method reduces the amount of preparation surfactant; it ranges from 1.5 to 2 g per course of treatment, while in the method-prototype 18 - 25 g, as shown in the equivalent semi-synthetic preparation of surfactant - 32-64, note that the cost of treatment of the prototype is estimated at 35,000 USD [24].

5. The method does not cause complications, while in the method prototype in 5 patients out of 29 developed severe complications: bilateral pneumothorax, pneumoperitoneum and pneumocele, and two patients were transferred extracorporeal membrane oxygenation in connection with increasing severity of DN.

6. An important advantage of the proposed method is the use of drugs Surfactant-HL and Surfactant-BL - natural pulmonary surfactants containing 89-93,8% of phospholipids, 4,2 to 9% neutral lipids, and characterized by a high content of surfactant-associated proteins was 2.0%. This, from our point of view, provides a more effective functioning of the drugs. It should be recalled that in the method prototype using surfactant containing 1.0% of these proteins, and in ways analogous to using a synthetic drug Exosurf, these proteins are absent, and semi-synthetic drugs contain only 0.1% of the surfactant-associated proteins.

The method developed by the staff of the Central research radiological Institute of the RF Ministry of health and technical staff tested in 13 patients of children with the syndrome of acute lung injury and respiratory distress syndrome of adults with positive results.

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A method of treating respiratory failure in critical conditions in children, including artificial ventilation and endotracheal introduction of natural lung surfactant, characterized in that as the surfactant, use of surfactant-BL" or "surfactant-HL", which is injected from the first hours of development of respiratory failure first bolus dose of 300 - 400 mg/m2and then in the form of an aerosol continuously for 1 to 3 days in the amount of 20 - 30 mg/h, after which the patient extabit.

 

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