Administration of Antimicrobials into Respiratory Tract: Methods to Improve Efficacy in the Treatment of Hospital-Acquired Pneumonia

Клиническая Микробиология и Антимикробная Химиотерапия. 2014; 16(3):185-194

​ Birkun A.A.
pneumonia antimicrobial therapy pulmonary surfactant inhalation instillation Pseudomonas aeruginosa heliox perfluorocarbon dry powder
Section
Diseases and Pathogens
Type
Journal article
Publication
Клиническая Микробиология и Антимикробная Химиотерапия. 2014; 16(3):185-194

Abstract

Despite the availability of substantial theoretical benefits, the method of antibacterial administration via the respiratory tract to treat acute pneumonia has yet to be widely implemented in clinical practice. The introduction of the method is restricted both by deficit of reliable clinical data to prove the effectiveness of such therapy, and by doubts as for efficacy of antibiotic delivery into the focus of pulmonary infection. The article presents a review of methods for enhancement of antibacterial therapy when administered via respiratory pathways. In particular, use of exogenous pulmonary surfactant as a promising agent for delivery of intratracheally administered antibiotics is discussed.

  • 1. Torres A., Ewig S., Lode H., Carlet J., European HAP working group. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2009; 35:9-29.
  • 2. Luyt C.E., Combes A., Nieszkowska A., Trouillet J.L., Chastre J. Nosocomial and Ventilator-Associated Pneumonia: Aerosolised treatment for VAP. Eur Respir Mon 2011; 53:54-65.
  • 3. Rouby J. J., Bouhemad B., Monsel A., Brisson H., Arbelot C., Lu Q. et al. Aerosolized antibiotics for ventilator-associated pneumonia: lessons from experimental studies. Anesthesiology 2012; 117:1364-80.
  • 4. Luyt C.E., Bréchot N., Combes A., Trouillet J.L., Chastre J. Delivering antibiotics to the lungs of patients with ventilator-associated pneumonia: an update. Expert Rev Anti Infect Ther 2013; 11:511-21.
  • 5. American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and health care-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388-416.
  • 6. Masterton R.G., Galloway A., French G., Street M., Armstrong J., Brown E., et al. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2008; 62:5-34.
  • 7. Chastre J., Luyt C.E. Other therapeutic modalities and practices: Implications for clinical trials of hospitalacquired or ventilator-associated pneumonia. Clin Infect Dis 2010; 51:S54-S58.
  • 8. Abu-Salah T., Dhand R. Inhaled antibiotic therapy for ventilator-associated tracheobronchitis and ventilator-associated pneumonia: an update. Adv Ther 2011; 28:728-47.
  • 9. Kollef M.H., Hamilton C.W., Montgomery A.B. Aerosolized antibiotics: do they add to the treatment of pneumonia? Curr Opin Infect Dis 2013; 26:538-44.
  • 10. Lu Q., Girardi C., Zhang M., Bouhemad B., Louchahi K., Petitjean O. et al. Nebulized and intravenous colistin in experimental pneumonia caused by Pseudomonas aeruginosa. Intensive Care Med 2010; 36:1147-55.
  • 11. Bigham M.T., Jacobs B.R., Monaco M.A., Brilli R.J., Wells D., Conway E.M. Helium/oxygen-driven albuterol nebulization in the management of children with status asthmaticus: a randomized, placebo-controlled trial. Pediatr Crit Care Med 2010; 11:356-61.
  • 12. Braun Filho L.R., Amantéa S.L., Becker A., Vitola L., Marta V.F., Krumenauer R. Use of helium-oxygen mixture (Heliox®) in the treatment of obstructive lower airway disease in a pediatric emergency department. J Pediatr (Rio J) 2010; 86:424-8.
  • 13. Brandão D.C., Britto M.C., Pessoa M.F., de Sá R.B., Alcoforado L., Matos L.O. Heliox and forward-leaning posture improve the efficacy of nebulized bronchodilator in acute asthma: a randomized trial. Respir Care 2011; 56:947-52.
  • 14. Alcoforado L., Brandão S., Rattes C., et al. Evaluation of lung function and deposition of aerosolized bronchodilators carried by heliox associated with positive expiratory pressure in stable asthmatics: a randomized clinical trial. Respir Med 2013; 107:1178-85.
  • 15. Tonnellier M., Ferrari F., Goldstein I., Sartorius A., Marquette C., Rouby J. Intravenous versus nebulized ceftazidime in ventilated piglets with and without experimental bronchopneumonia: comparative effects of helium and nitrogen. Anesthesiology 2005; 102:995-1000.
  • 16. Tawfic Q.A., Kausalya R. Liquid ventilation. Oman Med J 2011; 26:4-9.
  • 17. Burkhardt W., Kraft S., Ochs M., Proquitté H., Mense L., Rüdiger M. Persurf, a new method to improve surfactant delivery: a study in surfactant depleted rats. PLoS One 2012; 7: e47923. doi:10.1371/journal.pone.0047923.
  • 18. Murgia X., Mielgo V., Valls-i-Soler A., Ruiz-del-Yerro E., Rey-Santano C. Aerosolized perfluorocarbon improves gas exchange and pulmonary mechanics in preterm lambs with severe respiratory distress syndrome. Pediatr Res 2012; 72:393-9.
  • 19. Rey-Santano C., Mielgo V.E., Gastiasoro E., AlvarezDiaz F. J., Lafuente H., Valls-i-Soler A. et al. Comparative effects of bronchoalveolar lavage with saline, surfactant, or perfluorocarbon in experimental meconium aspiration syndrome. Pediatr Crit Care Med 2012; 13:187-94.
  • 20. Franz A.R., Röhlke W., Franke R.P., Ebsen M., Pohlandt F., Hummler H.D. Pulmonary administration of perfluorodecaline-gentamicin and perfluorodecalinevancomycin emulsions. Am J Respir Crit Care Med 2001; 164:1595-600.
  • 21. Dickson E.W., Doern G.V., Trevino L., Mazzoni M., Heard S.O. Prevention of descending pneumonia in rats with perflubron-delivered tobramycin. Acad Emerg Med 2003; 10:1019-23.
  • 22. Jeng M. J., Soong W. J., Chiou S.Y., Wu Y. T., Tsai T.H., Lin C. C. et al. Efficacy of intratracheal instillation of a meropenem/perfluorochemical suspension in acute lung injury. Pediatr Pulmonol 2012; 47:189-98.
  • 23. Schuster A., Haliburn C., Döring G., Goldman M.H.; Freedom Study Group. Safety, efficacy and convenience of colistimethate sodium dry powder for inhalation (Colobreathe DPI) in patients with cystic fibrosis: a randomised study. Thorax 2013; 68:344-50.
  • 24. Stass H., Nagelschmitz J., Willmann S., Delesen H., Gupta A., Baumann S. Inhalation of a dry powder ciprofloxacin formulation in healthy subjects: a phase I study. Clin Drug Investig 2013; 33:419-27.
  • 25. Wahjudi M., Murugappan S., van Merkerk R., Eissens A.C., Visser M.R., Hinrichs W.L. et al. Development of a dry, stable and inhalable acyl-homoserine-lactoneacylase powder formulation for the treatment of pulmonary Pseudomonas aeruginosa infections. Eur J Pharm Sci 2013; 48:637-43.
  • 26. Geller D.E., Weers J., Heuerding S. Development of an inhaled dry-powder formulation of tobramycin using PulmoSphere™ technology. J Aerosol Med Pulm Drug Deliv 2011; 24:175-82.
  • 27. Newhouse M.T., Hirst P.H., Duddu S.P., Walter Y.H., Tarara T.E., Clark A.R. et al. Inhalation of a dry powder tobramycin PulmoSphere formulation in healthy volunteers. Chest 2003; 124:360-6.
  • 28. Konstan M.W., Flume P.A., Kappler M., Chiron R., Higgins M., Brockhaus F. et al. Safety, efficacy and convenience of tobramycin inhalation powder in cystic fibrosis patients: The EAGER trial. J Cyst Fibros 2011; 10:54-61.
  • 29. Konstan M.W., Geller D.E., Minić P., Brockhaus F., Zhang J., Angyalosi G. Tobramycin inhalation powder for P. aeruginosa infection in cystic fibrosis: The EVOLVE trial. Pediatr Pulmonol 2011; 46:230-8.
  • 30. Lee S.H., Teo J., Heng D., Ng W. K., Chan H.K., Tan R.B. Synergistic combination dry powders for inhaled antimicrobial therapy: Formulation, characterization and in vitro evaluation. Eur J Pharm Biopharm 2012; pii: S0939- 6411(12)00285-8. doi:10.1016/j.ejpb.2012.09.002.
  • 31. Dharmadhikari A.S., Kabadi M., Gerety B., Hickey A. J., Fourie P.B., Nardell E. Phase I, single-dose, dose-escalating study of inhaled dry powder capreomycin: a new approach to therapy of drug-resistant tuberculosis. Antimicrob Agents Chemother 2013; 57:2613-9.
  • 32. Russo P., Stigliani M., Prota L., Auriemma G., Crescenzi C., Porta A. et al. Gentamicin and leucine inhalable powder: what about antipseudomonal activity and permeation through cystic fibrosis mucus? Int J Pharm 2013; 440:250-5.
  • 33. Hagemeister F., Rodriguez M. A., Deitcher S. R., Younes A., Fayad L., Goy A. et al. Long term results of a phase 2 study of vincristine sulfate liposome injection (Marqibo®) substituted for non-liposomal vincristine in cyclophosphamide, doxorubicin, vincristine, prednisone with or without rituximab for patients with untreated aggressive non-Hodgkin lymphomas. Br J Haematol 2013; 162:631-8.
  • 34. Hua S., Wu S. Y. The use of lipid-based nanocarriers for targeted pain therapies. Front Pharmacol 2013; 21:1-7.
  • 35. Dicheva B.M., Koning G.A. Targeted thermosensitive liposomes: an attractive novel approach for increased drug delivery to solid tumors. Expert Opin Drug Deliv 2014; 11:83-100.
  • 36. Kraft J.C., Freeling J.P., Wang Z., Ho R. J. Emerging research and clinical development trends of liposome and lipid nanoparticle drug delivery systems. J Pharm Sci 2014; 103:29-52.
  • 37. Alipour M., Suntres Z.E., Halwani M., Azghani A.O., Omri A. Activity and interactions of liposomal antibiotics in presence of polyanions and sputum of patients with cystic fibrosis. PLoS One 2009; 28: e5724. doi:10.1371/ journal.pone.0005724.
  • 38. Zhang L., Pornpattananangku D., Hu C.M., Huang C.M. Development of nanoparticles for antimicrobial drug delivery. Curr Med Chem 2010; 17:585-94.
  • 39. Kulkarni P.R., Yadav J.D., Vaidya K.A.Liposomes: a novel drug delivery system. Int J Curr Pharm Res 2011; 3:10-8.
  • 40. Drulis-Kawa Z., Dorotkiewicz-Jach A. Liposomes as delivery systems for antibiotics. Int J Pharm 2010; 387:187-98.
  • 41. Sawant R.R., Torchilin V.P. Challenges in development of targeted liposomal therapeutics. AAPS J 2012; 14:303-15.
  • 42. Allen T.M., Cullis P.R. Liposomal drug delivery systems: from concept to clinical applications. Adv Drug Del Rev 2013; 65:36-48.
  • 43. Koshkaryev A., Sawant R., Deshpande M., Torchilin V. Immunoconjugates and long circulating systems: origins, current state of the art and future directions. Adv Drug Del Rev 2013; 65:24-35.
  • 44. Zhang X., Sun P., Bi R., Wang J., Zhang N., Huang G. Targeted delivery of levofloxacin-liposomes for the treatment of pulmonary inflammation. J Drug Target 2009; 17:399-407.
  • 45. Chono S., Suzuki H., Togami K., Morimoto K.. Efficient drug delivery to lung epithelial lining fluid by aerosolization of ciprofloxacin incorporated into PEGylated liposomes for treatment of respiratory infections. Drug Dev Ind Pharm 2011; 37:367-72.
  • 46. Sun Q., Shi M., Shao W., Shi Y., Xi Y., Huang G. Tissue distribution and pulmonary targeting studies of cefpiramide sodium-loaded liposomes. J Drug Target 2011; 19:49-55.
  • 47. Alhajlan M., Alhariri M., Omri A. Efficacy and safety of liposomal clarithromycin and its effect on Pseudomonas aeruginosa virulence factors. Antimicrob Agents Chemother 2013; 57:2694-704.
  • 48. Alhariri M., Omri A. Efficacy of liposomal bismuth-ethanedithiol-loaded tobramycin after intratracheal administration in rats with pulmonary Pseudomonas aeruginosa infection. Antimicrob Agents Chemother 2013; 57:569- 78.
  • 49. de Jesús Valle M.J., González J.G., López F.G., Navarro A.S. Pulmonary disposition of vancomycin nebulized as lipid vesicles in rats. J Antibiot (Tokyo) 2013; 66:447-51.
  • 50. Lewis R.E., Albert N.P., Liao G., Wang W., Prince R.A., Kontoyiannis D.P. High-dose induction liposomal amphotericin B followed by de-escalation is effective in experimental Aspergillus terreus pneumonia. J Antimicrob Chemother 2013; 68:1148-51.
  • 51. Clancy J.P. Clinical trials of lipid-associated aerosolized amikacin: the ArikaceTM story. Pediatr Pulmonol 2009; 44:109-212.
  • 52. Weers J., Metzheiser B., Taylor G., Warren S., Meers P., Perkins W.R. A gamma scintigraphy study to investigate lung deposition and clearance of inhaled amikacin-loaded liposomes in healthy male volunteers. J Aerosol Med Pulm Drug Deliv 2009; 22:131-8.
  • 53. Clancy J.P., Dupont L., Konstan M.W., Billings J., Fustik S., Goss C.H. Phase II studies of nebulised Arikace in CF patients with Pseudomonas aeruginosa infection. Thorax 2013; 68:818-25.
  • 54. Cipolla D., Gonda I., Chan H.K. Liposomal formulations for inhalation. Ther Deliv 2013; 4:1047-72.
  • 55. Serisier D. J., Bilton D., De Soyza A., Thompson P. J., Kolbe J., Greville H.W. et al. Inhaled, dual release liposomal ciprofloxacin in non-cystic fibrosis bronchiectasis (ORBIT-2): a randomised, double-blind, placebo-controlled trial. Thorax 2013; 68:812-7.
  • 56. Sweet D.G., Halliday H.L. The use of surfactants in 2009. Arch Dis Child Educ Pract Ed 2009; 94:78-83.
  • 57. Gower W. A., Nogee L.M. Surfactant dysfunction. Paediatr Respir Rev 2011; 12:223-9.
  • 58. Glasser J.R., Mallampalli R.K. Surfactant and its role in the pathobiology of pulmonary infection. Microbes Infect 2012; 14:17-25.
  • 59. Загорулько А. К., Биркун А. А., Новиков Н.Ю. Сурфактантная система легких и заместительная сурфактантная терапия. Симферополь; 1995.
  • 60. Haitsma J. J., Lachmann U., Lachmann B. Exogenous surfactant as a drug delivery agent. Adv Drug Deliv Rev 2001; 47:197-207.
  • 61. Moreira L.M., Lyon J.P., Santos F.V., Albertini R., Aimbire F. Endogenous and exogenous pulmonary surfactants: biochemical mechanisms of alveolar actions. J Med Medic Sc 2010; 1:199-212.
  • 62. Willson D.F., Notter R.H. The future of exogenous surfactant therapy. Respir Care 2011; 56:1369-86.
  • 63. Tan K., Lai N.M., Sharma A. Surfactant for bacterial pneumonia in late preterm and term infants. Cochrane Database Syst Rev 2012; 2: CD008155. doi:10.1002/14651858.CD008155.pub2.
  • 64. El-Gendy N., Kaviratna A., Berkland C., Dhar P. Delivery and performance of surfactant replacement therapies to treat pulmonary disorders. Ther Deliv 2013; 4:951-80.
  • 65. Lopez E., Gascoin G., Flamant C., Merhi M., Tourneux P., Baud O. et al. Exogenous surfactant therapy in 2013: what is next? Who, when and how should we treat newborn infants in the future? BMC Pediatr 2013; 13:165. doi:10.1186/1471-2431-13-165.
  • 66. Polin R.A., Carlo W.A. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics 2014; 133:156-63.
  • 67. Yeh T.F., Lin H.C., Chang C.H., Wu T. S., Su B. H., L.T. C. et al. Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics 2008; 121: e1310- e1318. doi:10.1542/peds.2007-1973.
  • 68. Kharasch V.S., Sweeney T. D., Fredberg J., Lehr J., Damokosh A. I., Avery M.E. et al. Pulmonary surfactant as a vehicle for intratracheal delivery of technetium sulfur colloid and pentamidine in hamster lungs. Am Rev Respir Dis 1991; 144:909-13.
  • 69. Bernhard W., Pynn C. J. Therapeutic lung surfactants as carriers for other therapeutics -- a matter of vision, courage and determination. Pediatr Pulmonol 2009; 44:1157- 58. doi:10.1002/ppul.21123.
  • 70. Katkin J.P., Husser R.C., Langston C., Welty S.E. Exogenous surfactant enhances the delivery of recombinant adenoviral vectors to the lung. Hum Gene Ther 1997; 8:171-6.
  • 71. Ankermann T., Reisner A., Wiemann T., Koehler H., Krams M., Krause M.F. Intrapulmonary application of a 5-lipoxygenase inhibitor using surfactant as a carrier reduces lung edema in a piglet model of airway lavage. Pediatr Pulmonol 2006; 41:452-62.
  • 72. Ji Y., Liu C., Pei Y.Y. Artificial pulmonary surfactant as a carrier for intratracheally instilled insulin. Acta Pharmacol Sin 2007; 28:744-50.
  • 73. Nimmo A. J., Carstairs J.R., Patole S.K., Whitehall J., Davidson K., Vink R. Intratracheal administration of glucocorticoids using surfactant as a vehicle. Clin Exp Pharmacol Physiol 2002; 29:661-5.
  • 74. Dani C., Corsini I., Burchielli S., Cangiamila V., Longini M., Paternostro F. et al. Natural surfactant combined with beclomethasone decreases oxidative lung injury in the preterm lamb. Pediatr Pulmonol 2009; 44:1159-67.
  • 75. Yang C.F., Jeng M. J., Soong W. J., Lee Y.S., Tsao P.C., Tang R.B. Acute pathophysiological effects of intratracheal instillation of budesonide and exogenous surfactant in a neonatal surfactant-depleted piglet model. Pediatr Neonatol 2010; 51:219-26.
  • 76. Wang Y.E., Zhang H., Fan Q., Nealc C.R., Zuo Y.Y. Biophysical interaction between corticosteroids and natural surfactant preparation: implications for pulmonary drug delivery using surfactant as a carrier. Soft Matter 2012; 8:504-11.
  • 77. Mikolka P., Mokrá D., Kopincová J., TomčíkováMikušiaková L., Calkovská A. Budesonide added to modified porcine surfactant Curosurf may additionally improve the lung functions in meconium aspiration syndrome. Physiol Res 2013; 62: S191-200.
  • 78. Yang C.F., Lin C.H., Chiou S.Y. Intratracheal budesonide supplementation in addition to surfactant improves pulmonary outcome in surfactant-depleted newborn piglets. Pediatr Pulmonol 2013; 48:151-9.
  • 79. van ‘t Veen A., Mouton J. W., Gommers D. Influence of pulmonary surfactant on in vitro bactericidal activities of amoxicillin, ceftazidime, and tobramycin. Antimicrob Agents Chemother 1995; 39:329-33.
  • 80. van ‘t Veen A., Gommers D., Mouton J. W., Kluytmans J.A., Krijt E. J., Lachmann B. Exogenous pulmonary surfactant as a drug delivering agent: influence of antibiotics on surfactant activity. Br J Pharmacol 1996; 118:593-8.
  • 81. van’t Veen A., Mouton J. W., Gommers D., Lachmann B. Pulmonary surfactant as vehicle for intratracheally instilled tobramycin in mice infected with Klebsiella pneumoniae. Br J Pharmacol 1996; 119:1145-8.
  • 82. van’t Veen A., Gommers D., Verbrugge S. J. Lung clearance of intratracheally instilled 99mTc-tobramycin using pulmonary surfactant as vehicle. Br J Pharmacol 1999; 126:1091-6.
  • 83. Herting E., Gan X., Rauprich P., Jarstrand C., Robertson B. Combined treatment with surfactant and specific immunoglobulin reduces bacterial proliferation in experimental neonatal group B streptococcal pneumonia. Am J Resp Crit Care Med 1999; 159:1862-7.
  • 84. Stichtenoth G., Linderholm B., Björkman M. H., Walter G., Curstedt T., Herting E. Prophylactic intratracheal polymyxin B/surfactant prevents bacterial growth in neonatal Escherichia coli pneumonia of rabbits. Pediatr Res 2010; 67:369-74.
  • 85. Chimote G., Banerjee R. Evaluation of antitubercular drug-loaded surfactants as inhalable drug-delivery systems for pulmonary tuberculosis. J Biomed Mater Res A 2009; 89:281-92.
  • 86. Chimote G., Banerjee R. In vitro evaluation of inhalable isoniazid-loaded surfactant liposomes as an adjunct therapy in pulmonary tuberculosis. J Biomed Mater Res B Appl Biomater 2010; 94:1-10.
  • 87. Duan J., Vogt F.G., Li X., Hayes D.Jr, Mansour H.M. Design, characterization, and aerosolization of organic solution advanced spray-dried moxifloxacin and ofloxacin dipalmitoylphosphatidylcholine (DPPC) microparticulate/nanoparticulate powders for pulmonary inhalation aerosol delivery. Int J Nanomedicine 2013; 8:3489-505.
  • 88. Birkun A.A. Surfactant-enforced treatment of Pseudomonas-induced pneumonia. Proceedings of the European Respiratory Society Annual Congress; 2013 Sep 7-11; Barcelona, Spain; 2013. p. 137s.
  • 89. Birkun A.A. III, Krivorutchenko Y.L., Postnikova O.N., Babanin A.A., Novikov N.Y., Fedosov M. I. et al. Efficacy of combined surfactant-amikacin therapy in experimental pneumonia caused by Pseudomonas aeruginosa. Abstracts from The Aerosol Society Drug Delivery to the Lungs 23 Edinburgh International Conference Centre Edinburgh, Scotland, UK December 5–7, 2012. J Aerosol Med Pulm Drug Deliv 2013; 26: A-5.
  • 90. Биркун А.А., Криворутченко Ю.Л., Постникова О.Н., Бабанин А.А., Новиков Н.Ю., Федосов М.И. и др. Микробиологическая и физико-химическая оценка эффективности комбинированной терапии препаратом экзогенного сурфактанта и амикацином при экспериментальной пневмонии, вызванной Pseudomonas aeruginosa. Експериментальна і клінічна медицина 2013; 58:71-7.
  • 91. Birkun A.A. Exogenous pulmonary surfactant as a vehicle for antimicrobials: assessment of surfactant-antibacterial interactions in vitro. Scientifica 2014; 2014, Article ID 930318, 6 pages, 2014. doi:10.1155/2014/930318.
  • 92. Kuang Z., Hao Y., Hwang S., Zhang S., Kim E., Akinbi H.T. et al. The Pseudomonas aeruginosa flagellum confers resistance to pulmonary surfactant protein-A by impacting the production of exoproteases through quorum-sensing. Mol Microbiol 2011; 79:1220-35.
  • 93. Orgeig S., Hiemstra P.S., Veldhuizen E. J., Casals C., Clark H.W., Haczku A. et al. Recent advances in alveolar biology: evolution and function of alveolar proteins. Respir Physiol Neurobiol 2010; 173: S43-S54.
  • 94. Malloy J.L., Veldhuizen R. A., Thibodeaux B. A., O’Callaghan R. J., Wright J.R. Pseudomonas aeruginosa protease IV degrades surfactant proteins and inhibits surfactant host defense and biophysical functions. Am J Physiol Lung Cell Mol Physiol 2005; 288: L409-L418.
  • 95. Wu Y., Xu Z., Henderson F.C., Ryan A. J., Yahr T.L., Mallampalli R.K. Chronic Pseudomonas aeruginosa infection reduces surfactant levels by inhibiting its biosynthesis. Cell Microbiol 2007; 9:1062-72.
  • 96. Raghavendran K., Willson D., Notter R. H. Surfactant Therapy of ALI and ARDS. Crit Care Clin 2011; 27:525-59.
  • 97. Walsh B.K., Daigle B., DiBlasi R.M., Restrepo R.D., American Association for Respiratory Care. AARClinical Practice Guideline. Surfactant replacement therapy:2013. Respir Care 2013; 58:367-75.
  • 98. Jobe A.H. Lung maturation: the survival miracle of very low birth weight infants. Pediatr Neonatol 2010; 51:7-13.
  • 99. Zhang L.N., Sun J.P., Xue X.Y., Wang J.X. Exogenous pulmonary surfactant for acute respiratory distress syndrome in adults: A systematic review and meta-analysis. Exp Ther Med 2013; 5:237-42.
Views
0 Abstract
0 PDF
0 Crossref citations
Shared