RESUMO
Pulmonary surfactant deactivation is an important factor in the pathophysiology caused by wood smoke inhalation. Surfactant replacement is beneficial in treatment of surfactant-deficient neonates and possibly the adult respiratory distress syndrome (ARDS). In this study, the effect of exogenous Exosurf treatment for acute wood smoke injury was examined in four groups of rabbits. All groups were anaesthetized, placed on a ventilator, and surgically prepared for haemodynamic, peak airway pressure (P(aw)), and blood gas measurements. Rabbits were monitored for 2 h following smoke or sham smoke inhalation. At the conclusion of the experiment pulmonary oedema and surfactant function were measured. A Control group (n = 5) was followed without intervention. A Smoke group (n = 4) was ventilated with wood smoke for 3 min. A third group (Smoke+Exo, n = 4) was subjected to smoke followed by pulmonary instillation of Exosurf (5 ml/kg). Saline (5 ml/kg) was instilled into the lungs of the fourth group (n = 3) as a control for Exosurf instillation. Saline, Smoke and Smoke+Exo all significantly lowered PO2 and elevated P(aw) compared to baseline and the Control group. Exosurf treatment did not reduce the pulmonary oedema or restore surfactant function caused by smoke exposure. This study indicates that wood smoke inhalation acutely damages the lung and that administration of Exosurf by instillation is not an effective treatment.
Assuntos
Álcoois Graxos/administração & dosagem , Fosforilcolina , Polietilenoglicóis/administração & dosagem , Surfactantes Pulmonares/administração & dosagem , Lesão por Inalação de Fumaça/terapia , Resistência das Vias Respiratórias , Animais , Dióxido de Carbono/sangue , Combinação de Medicamentos , Água Extravascular Pulmonar , Instilação de Medicamentos , Pulmão , Complacência Pulmonar , Oxigênio/sangue , Edema Pulmonar/etiologia , Edema Pulmonar/patologia , Coelhos , Lesão por Inalação de Fumaça/sangue , Lesão por Inalação de Fumaça/complicações , Lesão por Inalação de Fumaça/fisiopatologia , Tensão Superficial , MadeiraRESUMO
Airway dilator or oral appliance therapy has been recommended with behavioral methods as treatment for patients with primary snoring or mild sleep apnea, unless there are patient-specific contraindications. Airway dilator therapy therefore may be a preferred treatment for patients with mild sleepiness and with fewer than 15 episodes of sleep disordered breathing per hour. The dentist's main diagnostic concern is to separate those patients with moderate or severe sleep apnea, who should be referred to a medical specialist for treatment, from those patients with primary snoring or mild sleep apnea, whom the dentist may treat primarily. Diagnostic tests including clinical predictions formulas, polysomnography, cardiorespiratory sleep studies, and oximetry will be discussed in this review.