ALI. (C, n = 8) NO ( n = 6) Surf ( n = 7) NO + Surf (SNO, n = 6) (N, n = 6) Surf 100 mg/ kg ;SNO NO Surf, 6 h, (PaO 2 / FiO 2 )

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1 Chin J Pediatr October 2003 Vol 41 No (Surf) (NO) (ALI) 33 5 : (C n = 8) NO + Surf (SNO n = 6) (N n = 6) ALI ;N ;NO NO h 30 min ;Surf Surf 100 mg/ kg ;SNO NO Surf 6 h NO C 30 min (PaO 2 / FiO 2 ) (Dynamic Compliance Cdyn) Cdyn SNO Surf NO NO Y NO (1020) 10-6 NO Surf NO ALI Surf NO ; ; Effects of combined surfactant and inhaled nitric oxide in ventilated rabbits with meconium aspiration2 induced acute lung injury HU Xiao2wei ZHU You2rong Lα Yong LAM Li Kuei ZHANG Ling2en SHAO Xiao2mei SUN Bo1 Laboratory of Pediatric Respiratory & Critical Care and Department of Pediatrics Children s Hospital of Fudan University Shanghai China Abstract Objective To evaluate dose response of inhaled nitric oxide (ino) for surfactant2treated rabbits with meconium aspiration2induced acute lung injury(ali) and hypoxemic respiratory failure ( HRF) and variation of measured ino by continuous NO delivery in pressure support ventilation ( PSV) 1 Methods Adult rabbits ( kg n = 33) were randomized to receive intratracheal meconium instillation for 30 min and subjected to following treatment ( n = 6-8). There were 4 groups : Control (C) ; NO ino at and each for 60 min at 30 min interval of disconnection ; Surf intratracheal instillation of porcine lung surfactant phospholipids (100 mg/ kg) ; SNO both ino and surfactant as in the NO and Surf groups ; and a normal group (N) which did not undergo meconium aspiration but received sham deliveries of normal saline1 All the animals were treated with PSV for 6 h1 ino levels at different input and sampling sites in the NO and SNO groups were detected by on2line chemiluminescent technique1 The blood gas and lung mechanics were measured during the experiments every 2 h1 Results (1) Meconium aspiration induced ALI and severe HRF ( PaO 2 / FiO 2 < 200 mmhg) and depressed dynamic compliance of respiratory system ( Cdyn) and airway resistance ( Raw) 1 In both Surf and NO groups modestly improved oxygenation was observed1 In the SNO values for PaO 2 / FiO 2 were improved from ( ) mmhg at baseline to ( ) mmhg at 6 h while moderate or transient improvement was observed in both Surf and NO groups1 Cdyn and Raw were only improved for short time in the Surf NO and SNO groups1 ino had a mild response at to good response at 10 and but no further improvement occurred at The response of ino in NO group was relatively transient compared to the SNO group1 (2) When ino was connected to the ventilator circuit the connected site should be placed before humidifier to minimize fluctuation of ino concentration and sampling site for ino monitoring should be placed : : ( ) ( ) ( )

2 Chin J Pediatr October 2003 Vol 41 No. 10 adequately to eliminate artifact1conclusions ino synergistically improved surfactant effects on oxygenation and lung mechanics1 Continuous supply of ino with non2continuous flow ventilator provided stable NO within accepted target range with least variation1 Key words Nitric oxide ; Meconium aspiration ; Pulmonary surfactants (MAS) ml) ; (4) Surf NO ( SNO n = 6) ) : NO Surf ( n = 6) Surf [1 ] (Surf) Surf Surf NO : (1) ( 900C ) : ( PSV) ] ; Surf NO ( PIP) 1530 cmh 2 O (ALI) (CPAP) 2 cmh 2 O (V T ) 68 ml/ NO kg (R) NO 4065 / min PIP R FiO 2 PaCO 2 [3 ] mmhg PaO 2 > 60 mmhg(2) Surf () NO : 510 ml/ (kg h) NO 5 % N 4 5 % 2 % g/ (kg h) 1. :33 ; 6 h kg 41 : (1) : 12 h 2 mg/ kg 15 min ( SC9000 ) (AVL 20 mg/ kg 35 mg/ (kg h) 993 ) (2) :Navigator 315 ( airway mm 22 resistance Raw) G 2. : 30 min 1 2 h 1 25 mg/ ml ] NO SNO NO 34 ml/ kg 3 ; 30 min 51 (ino) : NO ALI : SNO Cdyn 30 % PaO 2 / FiO mmhg ] 31 :ALI 30 min Y (D) 4 : (1) (C n = 8) : 3 ml/ kg ; (2) NO ( n = 6) : 3 ml/ kg (MetHb) (A B) NO NO (NO ) 1 (C D) NO h 30 min ; (3) : Surf [4 ] 100 mg/ kg (40 mg/ 5 min 2 mg/ kg [ (1030g/ (kgh) ] 011 mg/ kg hno (A) NO (280 Sievers) NO 2 ( gx s) Student2 Newman2Keuls

3 Chin J Pediatr October 2003 Vol 41 No t ; P < Raw 0105 Surf ino NO 2 %3 % ph PaCO 2 BE B NO C D NO NO (PaO 2 / FiO 2 ) Cdyn Raw ( P > 30 % (1 3) NO 0105) ; PaO 2 / FiO 2 NO 2 (2) Cdyn Raw ( P < 0101) Surf NO C ( P < 0105) N ( P < 0101) SNO Surf NO ( P < ) Surf () ino Cdyn Raw C 4 h (1) NO NO NO ino 1 h PaO 2 / FiO 2 ( P < 0105) ;SNO ino PaO 2 / FiO 2 ( P < 0105) NO NO ino ino : NO (A ) C D 30 % ( P < ) NO (A) Y 20 cm (B) ; Y (D) Y (C) NO NO (2) NO Cdyn [5 ] Surf Surf Surf PaO 2 / FiO 2 (mmhg) S N ( n = 6) 1 ( gx s) (h) # # F Cdyn [ml/ (cm H 2 O kg) ] S N ( n = 6) # # # # F Raw [cmh 2 O/ (L s) ] SNO( n = 6) N ( n = 6) F : 3 P < P < 0101 ;NO P < 0105 P < 0101 ;Surf P < 0105 P < 0101 ; NO # P < 0101

4 Chin J Pediatr October 2003 Vol 41 No ino( 10-6 ) 2 NO NO 2 ( gx s) NO : 3 P < 0105 n = 6 PaO 2 / FiO 2 (mmhg) SNO NO MetHb( %) SNO NO NO 2 ( 10-6 ) SNO NO ( 10-6 ) 3 NO ( gx s %) A C D B C D : 3 A C P < 0101 ) NO NO (1020) 10-6 [8 ] NO NO ( > 50 %) NO 900C [9 10 ] PSV (1 A ) NO NO 60 % NO 2 ; Y 20 cm (1 B ) NO 30 % NO NO [6 ] ino Surf NO ( > 30 %) : Surf ino Y (1 D ) NO ; Surf ino Cdyn Raw [7 ] : Surf Y (1 C ) NO ino NO NO ( ) NO NO ino FiO 2 / PaO 2 ino ino ALI NO ( 1 Cleary GM Antunes MJ Ciesielka DA et al. Exudative lung injury is associated with decreased levels of surfactant proteins in a rat model of meconium aspiration. Pediatrics : Sun B Curstedt T Robertson B. Exogenous Surfactant improves ventilation efficiency and alveolar expansion in rats with meconium aspiration. Am J Respir Crit Care Med : Francoe M Troncy E Blaise G. Inhaled nitric oxide : technical aspects of administration and monitoring. Crit Care Med : Zhu GF Sun B Niu SF et al. Combined surfactant therapy and inhaled nitric oxide in rabbits with oleic acid2induced acute respiratory distress syndrome. Am J Respir Crit Care Med : Sun B Curstedt T Song GW et al. Surfactant improves lung function and morphology in newborn rabbits with meconium aspiration. Biol

5 Chin J Pediatr October 2003 Vol 41 No Neonat : Huang QW Sun B Gao F et al. Effects of inhaled nitric oxide and high2frequency ventilation in rabbits with meconium aspiration. Biol Neonate : Sison C Bry C Sephus J et al. Effects of inhaled nitric oxide and surfactant treatment on lung function and pulmonary hemodynamics in bronchoalveolar lavage2induced respiratory failure. Pediatr Pulmonol : Kinsella JP Walsh WF Bose CB et al. Inhaled nitric oxide in premature neonates with severe hypoxemic respiratory failure : a randomised controlled trial. Lancet : Imanaka H Hess D Kirmse M et al. Inaccuracies of nitric oxide delivery systems during adult mechanical ventilation. Anesthesiology : Clark PL Ekekezie II Kaftan HA et al. Safety and efficacy of nitric oxie in chronic lung disease. Arch Dis Child Fetal Neonatal Ed : F412F45. ( : ) ( : ) 6 3 d 2002 ( + ) G262PD d 5 g(10 ) ;1 29 : U/ L ( U/ L) ( ) ; C mg/ L 1 d ( mg/ L) CD % CD % IgG 39 ; IgA IgM ; : :T 36 P 130 / min R 24 / min BP 98/ 45 mm Hg (13/ 6 kpa 1 mm Hg = kpa) ( ) 012 cm 11 d Hb 72 g/ L / cm 4 cm : ( - ) : (1) ( - ) ( - ) : :1 (1 26 ) :WBC / L N 0180 L 0120 RBC / L Hb 25 g/ L PLT / L ;2 (2 5 ) :WBC / L N 0150 L 0150 RBC / L Hb 72 g/ L PLT / L : / HP 25/ HP + + / LP :ph HCO mmol/ L BE mmol/ L : 112 U/ L 145 U/ L 2919mol/ (s L) (1 786 U/ L) 52mol/ L 911mol/ L 4219mol/ L : MB 6417 U/ L 20 nmol/ (s L) (1 222 U/ L) ; : mmol/ L 47512mol/ L : ( ) ; ( ) : [1 ; (2) ; (3) ] ] : ( : ) ( : )

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