The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

RADIOGRAPHIC APPEARANCE AFTER TOTAL BRONCHO-PULMONARY SEGMENTAL LAVAGE WITH SURFAXIN® IN ARDS

David Willms MD, Keith Kortman MD, Melissa Brown RRT-NPS Sharp Memorial Hospital, San Diego, California

Background: The feasibility of treatment of acute respiratory distress syndrome (ARDS) patients with segmental bronchoscopic lavage with a novel synthetic surfactant (SURFAXIN®) has been demonstrated in Phase I/II studies. We empirically noted transient worsening of chest x-ray (CXR) appearance of alveolar opacities in some cases shortly after treatment. This study investigated the appearance of CXRs done within 24 h of treatment of ARDS with SURFAXIN® lavage.

Methods:
The technique of segmental bronchoscopic surfactant lavage is described in Wiswell et al Am J Respir Crit Care Med 1999; 160:1188-95. Seven patients enrolled in 3 clinical trials of this therapy were studied if one or more CXRs were obtained within 2 h after bronchoscopic surfactant lavage. Some patients were treated twice, 48 h apart. A CXR scoring system was devised by the authors, grading each of 4 quadrants of the CXR as: 0 = clear, 1 = interstitial markings, 2 = ground glass infiltrate, 3 = consolidation. The sum of the 4 quadrant scores (maximum score = 12) was used to compare pre-lavage and post-lavage CXRs, and a "next day" CXR on the day after lavage treatment. Statistical comparison of mean values was assessed by the Mann-Whitney test.

Results:
Ten instances of lavage were studied in 7 subjects (4 male/ 3 female; mean age 43y; mean PaO2/ FiO2 ratio 123). CXRs were obtained a mean of 58.2 ± 34.1 min, range 21-104 ("immediate") and 14 ± 2.97 h, range 9.5-19 ("next day") after the lavage completion. Mean CXR appearance scores and p values are indicated in the Table below:

  Pre-Lavage Immediate Post-Lavage p value
CXR score 6.5 9.5 0.0009

  Immediate Post-Lavage Next day p value
CXR score 9.5 6.0 0.0004

  Pre-Lavage Next day p value
CXR score 6.5 6.0 0.3161

Conclusions: Mean scores of CXR infiltration worsen significantly in the immediate post-lavage period. On the day following lavage mean CXR score improves to baseline, but is not significantly better than the pre-lavage CXR.

Study supported by Discovery Laboratories, Doylestown, PA

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