Objective: Pilot close attention to investigate the effect of exogenous surfactant therapy in succession lung function following cardiopulmonary bypass (CPB) Design: Prospective randomized controll study Setting: Adult intensive care unit of a postgraduate cardiothoracic hospital.

Objective: Pilot close attention to investigate the effect of exogenous surfactant therapy in succession lung function following cardiopulmonary bypass (CPB)

Design: Prospective randomized controll study

Setting: Adult intensive care unit of a postgraduate cardiothoracic hospital.

Patients: Sixteen adult patients undergoing elective coronary artery revascularization surgery without a history of preoperative respiratory disease.

Interventions: Artificial lung-expanding pay with an abatement (ALEC, Britannia Pharmaceuticals, Crawley, UK) 32 g was given via a bronchoscope 60 min after bypass in eight patients. Eight repress subjects received air.

Main issue measurements: Lung function touchstones during IPPV (arterial blood gas tensions, Cr FRC TLCO KCO) were measured prior to CPB before therapy, and at regular intervals up to 180 min afterwards.

Results: The CPB caused a significant impairment of lung function in the two groups with an increase in A-a gradient ( + 47 [+ or -] 11 mm Hg in the ALEC cluster and + 44 [+ or -] 17 mm Hg in controls) and reductions in FRC (- 290 [+ or -] 121 ml in the ALEC assign places to and - 470 [+ or -] 132 ml in controls) TLCO (- 16 [+ or -] 03 ml/min/mm Hg in the ALEC arrange and - 2.2 [+ or -] 03 ml/min/mm Hg in the controls) and Cr (- 10 [+ or -] 1 ml/cm [Hsup2]O in the ALEC assemblage and - 21 [+ or -] 4 ml/cm [Hsup2]O in controls) The ALEC therapy did not affect A-a gradient, FRC and Cr compared with ascendencys However, TLCO was significantly lower in the ALEC form into groups following therapy (120 min after treatment - 01 [+ or -] 03 ml/min/mm Hg in ALEC form into groups and + 1.0 [+ or -] 03 ml/min/mm Hg in controls)

Conclusions: A single 32-g dose of ALEC administered as a bolus bronchoscopically does not improve lung function following CPB and may impair gas transfer.

Exogenous surfactant replacement therapy is established in the treatment of the neonatal respiratory distress syndrome[1] More newly attention has turned to assess the possible character of surfactant therapy in other conditions, including the adult respiratory distress syndrome (ARDS), as the associated abnormalities of gas exchange may be fit in part to pulmonary surfactant dysfunction. However, undertaking controll trials in this heterogeneous assemblage of conditions is fraught with logistical problems

The lung injury that tread close upons cardiopulmonary bypass (CPB) is associated with abnormalities of pulmonary surfactant. A decrease in the number of alveolar archetype 2 cells and a reduction in the surfactant-containing lamellar bodies in lung biopsy specimens of patients following CPB has been described.[2] In addition, bronchoalveolar lavage following CPB has revealed a temporary change in surfactant composition similar to that seen in ARDS, characterized according to a reduction in phosphotidylcholine (PC)[3] Lastly, we have shown newly that CPB results in a deterioration in lung function characterized according to a loss of lung compass a reduction in carbon monoxide transfer factor (TLCO) and an increase in alveolar arterial oxygen tension gradient (A-a gradient).[4] We postulated that this lung injury that invariably chases CPB may be a useful mould for assessing the effects of exogenous surfactant therapy.

Artificial lung-expanding settle (ALEC, Britannia Pharmaceuticals, Crawley, UK) is a synthetic mixture of the pair main naturally occurring surfactant phospholipids: PC and phosphotidylglycerol (PG) It has been shown to be highly effective in reducing mortality in neonates with respiratory distress syndrome[5] We have undertaken a pilot application of mind to assess the effects of treatment with ALEC in succession lung function following CPB.

METHODS

A randomized, prospective, controll trial was carried public with the approval of the Ethnics Committee of the Royal Brompton National Heart and Lung Hospital. Sixteen adult patients scheduled to have saphenous vein coronary artery bypass grafting and who gave informed consensus were recruited. Only patients having three or more grafts were studied and those with poor left ventricular function (left ventricular end-diastolic press [LVEDP] [greater than] 18 mm Hg) or a history of obstructive airways disease were exclud All patients were operated forward by one of two surgeon in order to make sure uniform surgical practice. Patients were randomly allocated to receive active treatment or control

Anesthesia and CPB Management

Patients were premedicated using 10 to 20 mg of oral temazepan (Wyeth Laboratories, Maidenhead, UK) Radial artery and central venous cannulas were inserted and general anesthesia was induced with alfentanil (Janssen Pharmaceuticals Ltd Wantage, UK) (50 [micro]g/kg), and pancuronium (Organon Laboratories Ltd Cambridge, UK) (015 mg/kg) The trachea was intubated and intermittent positive press ventilation (IPPV) was administered (Drager Evita Ventilator, Drager UK Ltd Hemel Hempstead, UK) The [FIO.sub.2] was maintained at 04 Anesthesia was continued with continuous infusions of propofol (3 to 5 mg/kg/h) and alfentanil (50 [micro]g/kg/h). No nitrous oxide was used. Fifteen minutes after induction of anesthesia, the preoperative measurements of lung function were made.

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