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Green TP, Timmons OD, Fackler JC, Moler FN, Thompson AE, Sweeney MF, for the Pediatric Critical Care Study Group: The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure. Crit Care Med 1996, 24:323-329. This paper is interesting because it concerns 331 patients evaluated during the same year of hospitalization, which is relatively rare in the ECMO cohorts.
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LeVine AM, Lotze A, Stanley S, Stroud C, O'Donnell R, Whitsett J, Pollack MM: Surfactant content in children with inflammatory lung disease. Crit Care Med 1996, 24:1062-1067. This paper documents abnormal tracheal aspirate surfactant phospholipids and surfactant protein A abnormalities in 60 children with bacterial pneumonia, viral pneumonitis, and ARDS, but not in 25 children on cardiopulmonary bypass nor in 35 controls. These data provide a clear rationale for exogenous surfactant therapy trials.
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Willson DF, Jiao JH, Bauman LA, Zaritsky A, Craft H, Dockery K, Conrad D, Dalton H: Calf's lung surfactant extract in acute hypoxemic respiratory failure in children. Crit Care Med 1996, 24:1316-1322.
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Willson, D.F.1
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Anzueto A, Baugham RP, Guntupalli KK, Weg JG, Wiedemann HP, Raventos AA, Lemaire F, Long W, Zaccardelli DS, Pattishall EN, for the Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group: Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. N Engl J Med 1996, 334:1417-1421. This paper reports the largest prospective, multicenter, double-blind, placebocontrolled trial of exogenous surfactant in 725 adult patients with sepsis-induced ARDS. There was no significant effect on 30-day mortality, length of stay in the intensive care unit, duration of mechanical ventilation, or physiologic function. These negative results are carefully discussed.
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Papo MC, Paczan PR, Fuhrman BP, Steinhorn DM, Hernan LJ, Leach CL, Holm BA, Fisher JE, Kahn BA: Perfluorocarbon-associated gas exchange improves lung mechanics, and survival in a model of adult respiratory distress syndrome. Crit Care Med 1996, 24:466-474.
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Tooley R, Hirschl RB, Parent A, Bartlett RH: Total liquid ventilation with perfluorocarbons increases pulmonary end-expiratory volume and compliance in the setting of lung atelectasis. Crit Care Med 1996, 24:268-273. This paper demonstrates that reexpansion of normal and saline-lavage surfactant-deficient atelectatic isolated cat lungs with total liquid ventilation was associated with a 11-fold increase in end-expiratory volume in comparison to gas ventilation. Thus, alveolar recruitment may be one of the main mechanisms by which gas exchanges are improved during total or partial liquid ventilation.
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