| Correlation between Changes of Intrapulmonary Right to Left Shunt and Improvements in Oxygenation after Exogenous Surfactant Administration in Preterm Respiratory Distress Syndrome |
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Sei Woo Chung |
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Department of Pediatrics, Inha University College of Medicine, Seongnam, Korea |
| 미숙아 호흡곤란 증후군에서 인공 폐 표면활성제 투여직후 폐 내 우→좌 단락의 변화와 산소화 호전의 상관관계 |
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정세우 |
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인하대학교 의과대학 소아과학교실 |
Correspondence:
Sei Woo Chung, Email: 1
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| Abstract |
Purpose
: This study was aimed to investigate the relationship between changes in intrapulmonary right to left shunt(QSP/QT) and improvements in oxygenation during the 2-hr study period after Surfactant-TA(S-TA) administration.
Methods
: Umbilical arterial blood gases and corresponding respiratory indexes of 27 preterm neonates with respiratory distress syndrome were studied. The neonates were separated into group A(n=20) and group B(n=7) according to whether their initial QSP/QT was above or below 30 %, respectively. And the patients were studied immediately before and after endotracheal single- dose S-TA administration within 6 hours after birth.
Results
: In the case of P(a/A)O2, group A showed a significant increase throughout the study period(P<0.01, P<0.001), whereas group B showed an initial significant increase at 2 hr(P<0.05). Significant correlations between changes in QSP/QT and improvements in P(a/A)O2 were seen in both groups(P<0.001, P<0.05). Moreover in the case of PaO2/FIO2, group A showed a significant increase throughout the study period(P<0.01, P<0.001), whereas group B showed an initial significant increase at 30 min(P<0.05). Significant correlations between changes in QSP/QT and improvements in PaO2/FIO2 were also seen in both groups(P<0.01, P<0.05). And at 2 hr, VEI and VA showed a significant increase in both groups(P<0.05, P<0.01), whereas PaCO2 showed a significant decrease in both groups(P<0.001, P<0.05).
Conclusion
: Irrespective of initial QSP/QT, immediate improvements in oxygenation following surfactant replacement were accomplished by recruiting atelectatic alveoli and stablizing underventilated alveoli(namely by decreasing QSP/QT). Moreover, the patients with more severe respiratory failure had a more rapid and sustained improvement in oxygenation. |
| Key Words:
Intrapulmonary right to left shunt(QSP/QT), Oxygenation, Respiratory distress syndrome, Surfactant-TA(S-TA), P(a/A)O2, PaO2/FIO2 |
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