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P Berggren

Publications and source records attributed to P Berggren.

12 recordsLinked to original sources
PubMed1992

A 2-year follow up of babies enrolled in a European multicentre trial of porcine surfactant replacement for severe neonatal respiratory distress syndrome. Collaborative European Multicentre Study Group.

The postnatal growth, respiratory status and neurodevelopmental outcome of surviving babies enrolled in the first European multicentre trial of porcine surfactant (Curosurf) replacement for severe neonatal respiratory distress syndrome, were assessed at corrected ages of 1 and 2 years. Follow up rates of survivors were 93% at 1 year and 89% at 2 years. Treated and control groups were similar at both 1 and 2 years in terms of physical growth, the prevalence of persistent respiratory symptoms and the occurrence of major and minor disability. Serum antibodies recognising Curosurf and surfactant-anti-surfactant immune complexes were detected in both treated and control babies, the titres showing no difference between groups. Examination of histological lung sections from non-survivors revealed a higher incidence of severe pulmonary interstitial emphysema in control babies than in those treated with surfactant. Surfactant treatment for severe respiratory distress syndrome reduces neonatal mortality and air leaks and is not associated with an increase in disability 2 years later.

Antibodies↗
PubMed1992

Bubbles and computer-aided image analysis for evaluation of surfactant inhibition.

Surfactant (Curosurf, diluted to 5 mg/ml) was suspended in normal saline with 3 mM CaCl2 and mixed with different concentrations of albumin or fibrinogen. The samples were vortexed to generate microbubbles, and the equivalent circle diameter of these bubbles was determined with computer-aided image analysis. Bubbles in the original surfactant suspension had an average diameter of 27 microns after 2 min, and their size increased only little during a 15-min period of observation. The diameter of bubbles generated in the presence of albumin (4 or 40 mg/ml) or fibrinogen (4 mg/ml) was 4-5 times larger, indicating surfactant inhibition. We conclude that evaluation of microbubble stability with image analysis provides an objective and rapid assessment of surfactant inhibition, and we speculate that the method could also be used for quantification of surfactant activity in airway samples.

Animals↗
PubMed1987

Two hydrophobic low-molecular-mass protein fractions of pulmonary surfactant. Characterization and biophysical activity.

Hydrophobic low-molecular-mass proteins were isolated from minced pig lungs and separated into two fractions. Electrophoresis of protein fraction 1 showed two major bands. Calculations of molecular masses from the electrophoretic mobilities are unreliable because of the extreme hydrophobicity of the peptides. However, the two bands were at positions corresponding to apparent molecular masses of about 3 kDa and 14 kDa, while sequence degradation disclosed only one major structure. Electrophoretic separation of protein fraction 2 revealed one band, at an apparent molecular mass of about 6 kDa. Microheterogeneities at the N terminus of both fractions were observed. However, the two fractions had different N-terminal structures and amino acid compositions. Consequently they are concluded to represent different polypeptides without common segments. Bronchoalveolar lavage from humans also contains surfactant polypeptides and at least the fraction 2 peptide is highly similar in human and porcine surfactants. Artificial surfactant preparations, obtained by recombination of protein fraction 1 or 2 with a mixture of synthetic phospholipids, were evaluated with the pulsating bubble method and in experiments on artificially ventilated premature newborn rabbits. The addition of protein fraction 1 to the phospholipid mixture improved surface adsorption from more than 300 s to about 2 s and reduced minimum surface tension from more than 20 mN/m to nearly 0 as measured with a pulsating bubble. When this surfactant preparation was instilled into the airways of newborn rabbits, the tidal volumes at insufflation pressure 25 cm H2O was increased about twentyfold compared to the volumes obtained in non-treated controls. Preparations based on protein fraction 1 had better in vitro and in vivo properties than those based on protein fraction 2. Both these protein-based preparations were decidedly more effective than phospholipids alone.

Amino Acid Sequence↗
PubMed1987

Endotracheal administration of surfactant in very low birth weight infants with respiratory distress syndrome.

This study was designed to evaluate whether the ventilatory maneuvers associated with surfactant replacement would, per se, influence oxygenation in newborn infants with severe respiratory distress syndrome. Eight patients (700 to 1400 g), all requiring mechanical ventilation with fraction of inspired oxygen greater than 0.6, were included in the trial; four were randomized to receive surfactant, and the others served as controls. Porcine surfactant (2 ml/kg; phospholipid concentration, 100 mg/ml) was instilled via a naso-endotracheal tube at end-expiration and dispersed into the lungs during a period of standardized "sighing" mediated by the ventilator: two prolonged ventilatory cycles (10 sec each) with an inspiration/expiration ratio of 4:1, followed by a 6-min ventilation with a frequency of 60 breath/min and an inspiration/expiration ratio of 4:1. Control babies received no surfactant but were otherwise subjected to the same ventilatory maneuvers. Surfactant-treated infants showed a rapid increase in transcutaneous oxygen associated with improved lung aeration in chest x-rays; the response was transient in three babies and persistent in one. No improvement was observed in control babies. We conclude that the beneficial effect of surfactant replacement cannot be attributed to the ventilatory maneuvers associated with the instillation procedure.

Critical Care↗
PubMed1987

Severe neonatal respiratory distress syndrome treated with the isolated phospholipid fraction of natural surfactant.

Ten newborn infants (795-1680 g) with severe respiratory distress syndrome (RDS) were treated with the isolated phospholipid fraction of bovine or porcine surfactant, which was administered via the airways (dose 200 mg/kg), at a median age of 10.5 h. Before receiving surfactant, all the infants were on artificial ventilation (FiO2 0.6-1.0). Within 2 h after surfactant replacement, the arterial-to-alveolar PO2 ratio increased from 0.1 to 0.35. There was a concomitant improvement in lung aeration on the chest roentgenograms and a significant reduction in the right-to-left shunt. Four patients died of cerebral hemorrhage; two of them also had a patent ductus arteriosus. One surviving infant developed bronchopulmonary dysplasia, and another succumbed 8 months later to the sudden infant death syndrome. No antibodies against surfactant were detected in the sera of the survivors. Since our results show a significant improvement in lung function after replacement therapy, the efficacy of this new surfactant preparation should be further tested in randomized clinical trials.

Chromatography, Gel↗
PubMed1986

Gas exchange and lung morphology after surfactant replacement in experimental adult respiratory distress syndrome induced by repeated lung lavage.

Severe respiratory insufficiency was induced in adult guinea pigs by repeated lung lavage. The animals were then ventilated for 75 min with 100% O2, insufflation pressure 28/6-8 cmH2O (2.7/0.6-0.8 kPa), frequency 30/min, and 33% inspiration time. One group of animals (I) was treated with protein-depleted porcine surfactant, prepared by a combination of sucrose-gradient centrifugation, heating to 90 degrees C, and chloroform/methanol extraction. Another group (II) received the phospholipid fraction of porcine surfactant, isolated from minced lungs by chloroform/methanol extraction and liquid-gel chromatography. Surfactant was administered in two 1-ml doses (lipid concentration 90 mg/ml) instilled via the tracheal cannula about 15 and 45 min after the lavage procedure. Non-treated, lavaged animals served as controls. After 75 min of ventilation, control values for PaO2 and PaCO2 were 13.3 +/- 6.8 and 6.8 +/- 2.3 kPa (mean +/- s.d.), respectively. The corresponding values in Group I of surfactant-treated animals were 52.9 +/- 7.7 and 4.4 +/- 1.1 kPa, in Group II 53.5 +/- 7.3 and 4.8 +/- 1.3 kPa (P less than 0.02-0.002). The two groups of surfactant-treated animals also had significantly improved alveolar air expansion in histological sections, as reflected by increased alveolar volume density (0.67 +/- 0.05 and 0.62 +/- 0.11 vs 0.45 +/- 0.08 in controls; P less than 0.002). The benefits of surfactant replacement in this experimental model were thus similar to those previously observed in animal models of neonatal surfactant deficiency as well as in babies with respiratory distress syndrome (RDS). Our data suggest that surfactant replacement might have a therapeutic effect also in clinical adult RDS.

Animals↗
PubMed1986

Correlations between physical and physiological properties of various preparations of lung surfactant.

The physical and physiological properties of natural surfactant were investigated after the addition of various synthetic lipids. Three types of surfactant were studied: 1. Bovine surfactant with rapid spreading (1.6 s) and a relatively high minimal surface tension during surface compression (16 mN/m). 2. The same surfactant enriched with dipalmitoylphosphatidylcholine (DPPC), tripalmitin, and palmitic acid showing slow spreading (55 s) and low minimal surface tension (5 mN/m). 3. The same surfactant enriched with DPPC and dipalmitin, showing rapid spreading (1.8 s) and low minimal surface tension (6 mN/m). The physiological properties of these surfactants were evaluated in immature newborn rabbits. All three preparations effectively improved lung expansion and stability in pressure-volume recordings, increased tidal volumes during artificial ventilation, and enhanced alveolar volume density in histological sections. The magnitude of the therapeutic effects was similar for non-enriched and enriched materials. Thus, wide variations in in vitro surface properties do not seem to influence the in vivo activity of the surfactant preparations.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1985

Surfactant treatment and ventilation by high frequency oscillation in premature newborn rabbits: effect on survival, lung aeration, and bronchiolar epithelial lesions.

Premature rabbit neonates delivered at gestational age 27 days were ventilated by high frequency oscillation for 60 min with 100% O2, using a frequency of 7-8 Hz, 50% inspiration time and mean airway pressures of 6-8 cm H2O. Twenty-five animals received bovine surfactant (2 ml/kg body weight; phospholipid concentration 85-100 mg/ml) in the tracheal cannula before onset of ventilation, and 22 littermates served as controls. In the surfactant-treated group, average tidal volume was about 10 times larger than in controls, yet only 15% of the estimated dead space. Judged from ECG recordings, the treated animals also had a much higher survival rate: 96 versus 5% (p less than 0.001). Morphometrically, mean alveolar volume density was increased in the surfactant-treated animals in comparison with controls: 0.65 +/- 0.08 versus 0.37 +/- 0.08 (means +/- SD; p less than 0.005). Bronchiolar epithelial lesions were found in all control animals and were severe in almost all cases. In the surfactant-treated group, epithelial lesions were absent in 12, mild in 11, and fairly prominent in two animals. We conclude that after treatment with surfactant, the premature newborn rabbit can be ventilated adequately with high frequency oscillation at comparatively low mean airway pressures and that surfactant replacement effectively reduces the development of epithelial lesions in conducting airways during high frequency oscillation.

Animals↗
PubMed1985

Physiological activity of pulmonary surfactant with low protein content: effect of enrichment with synthetic phospholipids.

A natural surfactant with low protein content (1%) was prepared by a sequence of cold centrifugation, heating to 90 degrees C, sucrose-gradient centrifugation, and extraction with chloroform:methanol. Some of the material was enriched with dipalmitoylphosphatidylcholine (DPPC) and unsaturated phosphatidylglycerol (PG) to relative concentrations of 56% and 10%, respectively. The in vitro physical properties of these preparations were evaluated with pulsating bubble and Wilhelmy balance and their in vivo activity with experiments on artificially ventilated premature newborn rabbits, delivered on day 27 of gestation. The animals were kept in body plethysmographs at 37 degrees C and ventilated artificially with a standardized sequence of insufflation pressures: 25, 20, and 15 cm H2O. The lungs were fixed by vascular perfusion and the alveolar expansion evaluated morphometrically in histologic sections. Enrichment of surfactant with DPPC and PG resulted in lower minimal surface tension during surface compression but did not further improve lung compliance or the alveolar expansion pattern. Treatment with nonenriched surfactant at a phospholipid concentration of 100 mg/ml (individual dose = 200 mg/kg) caused a markedly increased lung compliance at all insufflation pressure levels (p vs. controls less than .01). Our data indicate that pulmonary surfactant remains physiologically active after removal of most of its protein components and that enrichment with DPPC and PG reduces the in vitro minimal surface tension without adding to the in vivo efficacy.

Animals↗
PubMed1983

Automated techniques for the study of lung alveolar stereological parameters with the IBAS image analyser on optical microscopy sections.

In the case of lung alveoli, the good contrast of the features allows the use of a fully automated image analysing procedure, yielding many of the desirable stereological parameters which can be estimated on optical microscopy slides: alveolar volume and surface densities, a form factor and average mean integral curvature. With our program, specially designed for the IBAS image analyser (Kontron Bildanalyse, Munich, B.R.D.), the whole automated process takes an average of 28 s per field. The image analyser-obtained stereological estimates compare well with those given by point and intersection counting methods. Some difficulties inherent in image analysers arise when measuring alveolar boundary lengths: a scheme is therefore proposed which eliminates the image-edge errors, with no sampling bias, by comparing three different frames inside each field. A solution to the problem of estimating automatically the positive and negative tangent counts, necessary for the curvature calculations, is also proposed. Our program has been applied routinely to the study of premature newborn rabbit lung alveoli, as part of a work dealing with an evaluation of the possibility of preventing the respiratory distress syndrome by the administration of heterologous surfactant.

Animals↗
PubMed1972

[Brain death].

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Brain Death↗