RESUMEN
BACKGROUND: Exposure to indoor fungus growth and tobacco smoke has been epidemiologically linked to unexplained pulmonary hemorrhage in infants. OBJECTIVE: To describe the 40-day-old male infant who had been exposed to fungi for a discrete 2-week period followed by acute exposure to environmental tobacco smoke prior to development of a life-threatening pulmonary hemorrhage. PATIENT AND METHODS: History and clinical evaluation of the infant immediately followed the pulmonary hemorrhage. Air and surface sampling for isolation and identification of fungal growth in the dwelling where the infant resided before the acute hemorrhage was accomplished when the homeowner returned from vacation 4 months after the clinical event. RESULTS: Two fungi associated with mycotoxin production were cultured from surface samples collected in the residence: Penicillium (possibly Penicillium purpurogenum) and a Trichoderma species. Stachybotrys atra was not isolated from air or surface samples. Environmental tobacco smoke exposure occurred over a discrete several-hour period prior to onset of the acute pulmonary hemorrhage. CONCLUSIONS: Avoidance of unnecessary exposure of infants to fungus growth in water-damaged environments or exposure to tobacco smoke is prudent. Further investigation into the toxic effects of indoor fungi as causes of infantile pulmonary hemorrhage is warranted.
Asunto(s)
Contaminación del Aire Interior/efectos adversos , Hemorragia/etiología , Enfermedades Pulmonares/etiología , Micotoxinas/efectos adversos , Penicillium , Contaminación por Humo de Tabaco/efectos adversos , Trichoderma , Humanos , Lactante , Masculino , Factores de RiesgoRESUMEN
OBJECTIVE: Prospective study of the efficacy of calf lung surfactant extract in pediatric respiratory failure. DESIGN: Multi-institutional, prospective, randomized, controlled, unblinded trial. SETTING: Eight pediatric intensive care units (ICU) of tertiary medical centers. PATIENTS: Forty-two children with acute hypoxemic respiratory failure characterized by diffuse, bilateral pulmonary infiltrates, need for ventilatory support, and an oxygenation index of >7. INTERVENTION: Instillation of intratracheal surfactant (80 mL/m2). MEASUREMENTS AND MAIN RESULTS: Ventilator parameters, arterial blood gases, and derived oxygenation and ventilation indices were recorded before and at intervals after surfactant administration. Complications and outcome measures, including mortality, duration of mechanical ventilation, and length of pediatric ICU and hospital stay, were also examined. Patients who received surfactant demonstrated rapid improvement in oxygenation and, on average, were extubated 4.2 days (32%) sooner and spent 5 fewer days (30%) in pediatric intensive care than control patients. There was no difference in mortality or overall hospital stay. Surfactant administration was associated with no serious adverse effects. CONCLUSIONS: Administration of calf lung surfactant extract, calfactant, appears to be safe and is associated with rapid improvement in oxygenation, earlier extubation, and decreased requirement for intensive care in children with acute hypoxemic respiratory failure. Further study is needed, however, before widespread use in pediatric respiratory failure can be recommended.
Asunto(s)
Productos Biológicos , Cuidados Críticos , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Insuficiencia Respiratoria/tratamiento farmacológico , Adolescente , Niño , Preescolar , Cuidados Críticos/métodos , Femenino , Humanos , Hipoxia/tratamiento farmacológico , Hipoxia/fisiopatología , Lactante , Recién Nacido , Masculino , Mid-Atlantic Region , Estudios Prospectivos , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Insuficiencia Respiratoria/fisiopatología , Resultado del TratamientoRESUMEN
We studied the rate of clearance of treatment doses of radiolabeled calf lung surfactant extract, which was instilled into the lungs of young adult rabbits exposed to air (control) or 100% oxygen for 64 h. More than 75% of the instilled surfactant remained lung-associated at all time points up to 24 h post-instillation in both groups; however, significantly more of the labeled phosphatidylcholine (PC) remained in the alveolar wash of oxygen-exposed rabbits (44 +/- 9% in 100% O2 versus 27 +/- 5% in controls at 6 h and 27 +/- 2% in 100% O2 versus 6 +/- 1% in control rabbits at 24 h, p < 0.05). Less of the labeled PC could be found in type II pneumocytes isolated from the oxygen exposed animals than in control animals, both at 6 h (24 +/- 2 cpm/10(6) cells in O2 versus 38 +/- 7 cpm/10(6) cells in control) and 24 h (42 +/- 5 cpm/10(6) cells in O2 versus 70 +/- 12 cpm/10(6) cells in control) post-instillation. Type II cells from animals exposed to 100% oxygen also demonstrated significantly lower PC synthesis rates than cells from lungs of control animals. Interestingly, clearance of exogenous surfactant in rabbits exposed to 100% oxygen for 48 h, an exposure that does not cause significant type II pneumocyte dysfunction, was not different from control. We concluded that injury to type II pneumocytes may result in decreased clearance of instilled surfactant from the alveolar space and may be important in determining dosing regimens for the use of surfactant therapy in adult respiratory distress syndrome.