RU2149014C1 - Method of treatment of patients with acute bronchopneumonia complicated with atelectasis - Google Patents

Abstract

FIELD: medicine, pulmonology, pediatrics. SUBSTANCE: method involves carrying out of selective sanative bronchoscopy and administration of pulmonary surfactant as the preparation "surfactant-BL" which is administrated by a single dose or 2-3 times at break for 2-3 days in the amount 100-300 mg per one dose. Method provides high incidence of complete (or partial) recovery of atelectasis and decrease of patients treatment, decreases numbers of necessary sanative fibrobronchoscopies and probability of disease conversion to the chronic form. Invention can be used for treatment of children with acute bronchopneumonia complicated with atelectasis as bronchopneumonia complication. EFFECT: enhanced effectiveness of treatment. 2 cl, 1 tbl, 5 ex

Description

 The invention relates to medicine, more specifically to pulmonology, and may find application in the treatment of various forms of pulmonary pathology.

 The present invention relates to the treatment of mainly children aged 1 month to 14 years with acute bronchopneumonia (OBN) complicated by atelectasis (atelectasis) (AT), which (which) occur at different times of pneumonia and are characterized by resistance to traditional methods of treatment of AT.

 Atelectasis of the lung is a non-breathing, collapsed area (lobe, segment, subsegment) of the lung, which on the chest x-ray looks like a blackout in the shape of a triangle, usually with clear boundaries.

 Acute bronchopneumonia complicated by the formation of persistent atelectasis (atelectasis) is understood as an acute infiltrative lesion of the pulmonary parenchyma of bacterial or bacterial-viral etiology, accompanied by symptoms of general intoxication (loss of appetite, febrile or subfebrile temperature, tachycardia, weakness, respiratory failure, weakness,) expiratory or mixed dyspnea, cough), altered physical data (local shortening of percussion sound over the AT zone, dry and different alibernye rales) and with clear signs subsegmental, segmental or equity AT on the roentgenogram (Rg-MME) of the chest. These ATs are characterized by persistence (existence of more than 5 - 7 days) and lack of resolution (expansion) when using traditional methods of treatment (TSL). In TSL AT, which developed as a complication of OBN, antibiotic and (or) antiviral therapy, immunocorrective, mucolytic therapy and physiotherapeutic (FZT) methods of exposure are used. The latter include high-frequency current therapy, pulse electrophoresis with antispasmodic, mucolytic drugs and angioprotectors (trental, aminophylline), aminophylline phonophoresis and laser therapy. Along with this, inhalation therapy with antispasmodic and mucolytics is used (lazolvan, atrovent and berodual). In addition, massage and physiotherapy exercises (exercise therapy) are used in treatment [1, 2].

 In the absence of a quick (5 - 7 days) effect from the specified therapy, an invasive method of treatment of AT is used. It consists in the use of sanitation bronchoscopy and fibrobronchoscopy (PBS) with lavation (washing) of the AT zone with 0.9% isotonic sodium chloride solution with the addition of mucolytics [1, 2].

 Respiratory diseases are in first place among the overall incidence of children (79,000 per 100,000 children under the age of 14 years old). This applies to all diseases of the respiratory system, not just OBP (3). However, more accurate data on the incidence rate of children with OBP for 1998 in St. Petersburg can be given. It comprises 2866 patients who received inpatient treatment and 8960 children who received treatment extrapolation of these values to the population of Russia in relation to OBP in children treated in a hospital gives a value of 85,980 patients annually.

 The incidence of AT as a complication of OBN in children is 16.7% of all OBN [4]. Extrapolation to the population of Russia suggests that about 15,000 children annually suffer from OBP complicated by AT.

 This indicates that any new method, more effective in comparison with TSL of pulmonary pathology, deserves the close attention of specialists.

It is important to note that traditional treatment methods for persistent AT are characterized by the following significant disadvantages:
1. Full resolution of atelectasis occurs in 57% - 60% of cases and requires multiple (5 -6) debridement bronchial or FBS to achieve this result. This procedure is extremely traumatic, and in children under 10 years of age requires the use of general anesthesia. The procedure itself often leads to a short-term (within 1-2 days) worsening of the general condition of patients.

 2. The long-term existence of AT often (in 10% -12% of cases) leads to fibrosis of the site (segment) of the lung, persistence in this zone of bacterial (purulent) infection, the development of deforming bronchitis with areas of pneumosclerosis or the formation of bronchiectasis. In the latter case, there is a need for surgical treatment of such patients.

 The most common causes of OBF are bacterial and (or) bacterial-viral infections, immunogenetically determined structural and functional characteristics of the child’s bronchial wall and mucociliary clearance disorders (physiological elimination of bronchial secretions), unstable premorbid state, transferred by OBF at an early age (in during the first year of life).

 In the last 4–5 years, along with traditional methods of treatment, AT have been trying to use selective administration of pulmonary surfactant (CT) preparations. Basically, these works relate to the treatment of AT with multiple injuries arising from prolonged anesthesia during large abdominal or cardiac surgery. However, these individual works relate to the treatment of AT, arising directly in the process of treatment (surgery), and not the acute inflammatory process, which are OBP. These “fresh” ATs are also sometimes not treatable by conventional methods.

 As for the treatment of persistent (more than 5 - 7 days) atelectasis, which arose as a complication of OBP, we did not find such work where pulmonary surfactant preparations were used.

 The most widely used pulmonary surfactant preparations are used in the treatment of respiratory distress syndrome of the newborn (RDSN) [5].

 Synthetic (Exosurf, Glaxo-Wellcome, USA-Great Britain; ALEC, Britanica, Great Britain), semi-synthetic (Surfactant-TA, Tokyo Tanabe, Tokyo, Japan; Survanta, Ross / Abbott Lab, Chicago, USA) and natural pulmonary surfactant preparations are known ( Curosurf, Chiesi Farmaceutici, Farma, Italy; Alveofact, Thome GmbH, Biberach, Germany; Infasurf, Forrest Labs, St. Louis, USA; CLSE, Rochester, NY, USA; Surfactant-HL [6] and Surfactant-BL [7] .

Surfactant-HL and Surfactant-BL preparations were developed at the Central Research Radiological and Radiological Institute of the Ministry of Health of the Russian Federation (TsNIRRI Ministry of Health of the Russian Federation), St. Petersburg. Surfactant-HL is approved for widespread medical use by the decision of the Pharmacological Committee (FC) of the Ministry of Health of the Russian Federation (Protocol No. 3 of 04.15.99). Surfactant-BL is allowed for clinical trials with RDS for newborns (Protocol FC MH RF N 14 of 09/26/96) and for RDS adults (Protocol FC MH RF N 5 of 08/28/98). The State Pharmacopoeia Committee in 1998 approved the VFS on Surfactant-BL (N 42-3120-98). Clinical trials of Surfactant-BL successfully pass in 12 healthcare institutions in Moscow, St. Petersburg, Chelyabinsk and Yekaterinburg, and now more than 60 newborns have received treatment with this drug and more than 40 adults and young and older children. By the end of 1999, these tests should be completed and the reports of the clinics will be submitted to the Pharmacological Committee of the Ministry of Health of the Russian Federation in order to obtain permission for the medical use of Surfactant-BL. At present, the Central Research Institute of Healthcare of the Ministry of Health of the Russian Federation has created the basis for the production of pulmonary surfactant preparations with a capacity of 30 thousand bottles per year, and it will allow the introduction of drugs in practical health care for the treatment of critical conditions of newborns and adults
4 Some basic characteristics of the composition of these drugs are given in table. 1 [6, 7, 8].

 A known method of treating acute AT in a patient 48 years old [9]. The authors described the treatment of a patient undergoing mechanical ventilation (IVL) in the intensive care unit after a serious car injury. On the 9th day the patient was in intensive care, he found an AT of the left lung, which could not be smoothed out by traditional methods of treatment. Against the background of mechanical ventilation (separately of each lung), the patient was bolus injected with Exosurf surfactant in the amount of 50 mg / kg. A few hours after the introduction of surfactant against the background of ongoing mechanical ventilation, the AT of the left lung was completely expanded and the gas composition of the blood was normalized.

 There is a method of treating AT in a 35-year-old patient, in whom, due to the persistence of Staphylococcus aureus, spontaneous abortion occurred at a period of 7-8 weeks [10]. The patient developed sepsis, adult respiratory distress syndrome (RDSV), later pneumonia caused by Pseudomonas aeruginosa began, and an incomplete left lung AT occurred. Against the background of mechanical ventilation (separately of each lung), 1 g of natural pulmonary surfactant Alveofact was introduced using PBS. The patient showed an improvement in oxygenation and there were clinical and radiological signs of improved air filling of the atelectasized lung.

However, the above methods of treating AT, which developed as a complication of OBN, are characterized by
1. long-term treatment of patients
2. the need to use multiple (4-6) traumatic bronchoscopy or fibrobronchoscopy (in children under 10 years under general anesthesia),
3. insufficient treatment effectiveness (full resolution of AT is observed only in 58 - 60% of cases),
4. A large number of cases of the disease (presence of AT), becoming chronic, complicated by bronchiectasis and requiring further surgical treatment.

 As already mentioned, we did not find any work related to the use of pulmonary surfactant for the treatment of AT, which developed as a complication of OBN in children.

 The only report on the treatment of bilateral bronchopneumonia in a child of 1 g for 4 months, in whom the so-called migratory atelectasis was observed against the background of the most severe bilateral bronchopneumonia, was made by us in [11], which we take as a prototype.

A girl in critical condition with a diagnosis of generalized viral-bacterial infection, bilateral large-focal pneumonia, migratory lobar atelectases, stage III severity. Due to the severity of the condition, the girl was twice (daily) injected with Surfactant-BL at a dose of 400 mg / m ² in the form of an aerosol through a nebulizer due to the severity of the condition. Moreover, before the introduction of CT, the child was on mechanical ventilation for 10 days without positive dynamics in relation to the severity of the condition and the course of OBP. Migrating AT is characterized by the fact that it exists for a short time (2-3 days), and then occurs in another place. This AT behavior is primarily associated not with the pathological process in the parenchyma of the lung site in which inflammation (pneumonia) occurs, but with the pathological state of the bronchial tree. Such migratory ATs are mainly found in children suffering from bronchopulmonary dysplasia. After the second session of inhalation administration of the drug during the day, a significant improvement in the general condition of the child occurred, the parameters of blood gases returned to normal, the girl was extubated, mechanical ventilation was stopped and the migrating ATs disappeared.

 The prototype method, like analogues, is characterized by the same disadvantages. In addition, this treatment case concerns AT bronchogenic genesis, and not as a complication of OBN. However, the successful result we obtained from this child allowed us to further use the introduction of pulmonary surfactant in the treatment of AT, which arose as a complication of OBN, which, we repeat, is not described before the present invention.

 The technical result of the present invention is to increase the frequency of the complete solvability (elimination) of AT complicating OBN and reducing the treatment time.

 This result is achieved by the fact that pulmonary surfactant is administered once or 2 to 3 times with an interval of 2 to 3 days in an amount of 100 to 300 mg per administration using selective fibrobronchoscopy, and if a pronounced inflammation of the bronchial wall is detected, the surfactant is administered after 2-3 days with repeated bronchoscopy.

 It is advisable to use natural pulmonary surfactant with a phospholipid content of 89–93.8%, neutral lipids of 4.2–9% and surfactant-associated proteins of 2%.

 Engaged in the professional treatment of OBN complicated by persistent AT, and over the past year and with the use of pulmonary surfactant preparations, we have obtained positive results in several children in the form of complete, within 3-5 days, AT expansion after two or three administration of the drug.

 This fact prompted us to conduct special monitoring of the course of the disease in various modes of CT therapy in children with different periods (up to 10 days) from the moment of detection of AT. We injected surfactant preparations selectively, bolus into the lobar, segmental or subsegmental bronchi, using the preliminary zone lavage of the AT zone with isotonic sodium chloride solution, and CT was administered after 2 to 3 days between administrations.

 Having received in most cases positive results from such a treatment regimen, we attempted to extend it to AT treatment with a limitation period of up to 45 days.

 Having obtained good treatment results for 6 children with OBF with AT, three of whom had a segmental AT duration of 30–45 days, we consider the proposed regimen of CT therapy to be optimal.

 For treatment, we used Surfactant-BL, obtained from the lungs of cattle, or Surfactant-HL from the amniotic fluid of women in labor. These CTs contain 89% - 93.8% phospholipids, 4.2% -9% neutral lipids and 2.0% surfactant-associated proteins, which we injected in an amount of 100-300 mg for 1-3 times in 2-3 days.

 The introduction of surfactant selectively into the AT zone, where there are structural and functional damage to the alveolocytes, as we have shown in the experiment, leads to the restoration of the second type of alveolocytes - cells synthesizing surfactant [12]. The massive introduction of ST emulsion, which is in the alveolar space in the form of vesicular structures with a very large surface, leads to the sorption of toxic components on this surface and their removal due to mucociliary clearance with sputum.

 Repeated administration of surfactant, if AT does not straighten after the first injection, leads to further sanitation of the AT zone and compensates for the deficiency of its own surfactant arising from the destruction of its bacterial flora and inflammatory cells (polymorphonuclear leukocytes and their degrading enzymes).

 The use of a preparation containing, as mentioned above, 2.0% surfactant-associated proteins, in our opinion, is a very important component of the proposed method. Such proteins are absent in synthetic surfactant preparations (Exosurf), contained in an amount of 0.1% in semi-synthetic preparations (Survanta) and 1.0% - 1.5% in natural ones (Alveofact, Infasurf and CLSE) (see table. 1) .

 1. These proteins are very important for the ability of surfactant phospholipids to reduce surface tension at the interface (alveolar surface - air), while synthetic preparations, such as Exosurf, do not contain these proteins. A decrease in the surface tension force on the surface of the pulmonary alveoli, carried out by phospholipids in cooperation with surfactant-associated proteins, facilitates the process of opening of the alveoli during inspiration, reducing the necessary chest muscle effort [13].

 2. Associated with these proteins are the resistance of the native surfactant to inactivation, the chemiatric activity of the surfactant with respect to alveolar macrophages, the presence of which in the alveolar space is a positive prognostic factor for the course of inflammation, and the ability to stimulate complement and antibody-dependent uptake of pathogenic bacteria and alveolar viruses. d. [14, 15, 16].

 3. In addition, they inhibit the ability of polymorphonuclear leukocytes and alveolar macrophages to excrete (release) cytokines, the molecular components of the pro-inflammatory cascade. The latter damage the alveolar-capillary membrane, the main structural and functional unit of pulmonary gas exchange [17].

 The introduction of surfactant during the second PBS (it was not administered during the first because of inflammatory edema of the bronchial wall) allows, after a small sanitation of the supplying bronchus, to introduce a powerful drug into the AT zone, which in this case is natural surfactant.

 The amount of surfactant administered (100-300 mg) daily for 1-3 days is small, and despite the high cost of pulmonary surfactant preparations, it may be available for the treatment of a wide range of patients. This is very important, given the high cost of surfactant preparations [18, 19].

 The proposed treatment regimen for OBN with AT can significantly increase the complete elimination of AT, achieve a significant increase in their partial resolution with an AT life of 30 to 45 days, significantly reduce the number of traumatic FBS, reduce the number of cases in which AT becomes chronic, and requires further surgery.

 The essence of the method is as follows.

 At the first FBS with preliminary lavage of the AT zone, a sick child with an OBPN clinic complicated by AT is administered bolus selectively in the amount of 2.5-5.0 ml of physiological solution of sodium chloride 100-300 mg of Surfactant. In the case of incomplete elimination of AT, PBS with CT administration is repeated one or two more times at the same dose. The introduction of the drug is usually limited to 1 to 3 doses.

 The essence of the method is illustrated by the following examples.

 Example 1

 Boy Alexey G. 5.5 years, N East. disease 1442, was treated in the XI department (department of infectious pulmonology) Children's City Hospital (Children's Hospital) N 19 named. K.A. Raukhfusa (St. Petersburg) from 02/04/99 to 02/19/99 with a diagnosis of acute segmental bronchopneumonia (S6-S10 lung segments), respiratory failure (DN) -I severity. Complication: AT S8-S10 (numbering of lung segments) of the lower lobe of the left lung. Reactive pleurisy. Upon receipt of a complaint of a cough with discharge of mucopurulent sputum, weakness. Moderate severity, moderate intoxication syndrome, DN-1. During the examination: shortening of percussion sound above the lower lobe of the left lung, bronchial breathing and rales of various sizes. On the chest x-ray: infiltration of the focal-confluent character S6-S10, partial AT S8-S10. Laboratory: relative neutrophilia with a shift to the left, ESR - 20 mm / hour. Sick for 20 days before hospitalization. Onset of the disease: influenza, infiltrative changes were detected on Rg-mm (16th day of illness), the AT period at the time of admission to Children's Hospital No 19 was 20 days.

 Treatment: one course of antibiotics, aminophylline 6 mg / kg per day, physiotherapy (PTF), physiotherapy exercises (exercise therapy). On the first day of hospitalization, a rehabilitation PBS was performed with the introduction of 150 mg of Surfactant-HL in a volume of 5.0 ml of physiological saline (RF). On Rg-mma, 3 days after the administration of CT, the full resolution of AT (on the 23rd day of its formation) and the clinical and radiological resolution of pneumonia. The child received 150 mg of CT once, the AT resolution period was 3 days after CT administration, and after another 3 days the child was discharged home.

 Example 2

 Girl Irina S. 4 years and 10 months, N East. disease 13730, was treated in the XI Department of Children's Hospital No 19 from 11/25/98 to 12/17/98 with a diagnosis of acute focal-confluent right-sided (S4-S10) bronchopneumonia, DN-II, reactive pleurisy, complication - AT S4-S5 of the right lung . Complaints about unproductive cough, weakness. On admission, a moderate state, moderate intoxication syndrome, blunting of percussion sound over the middle lobe of the right lung, hard breathing weakened above S4-S5 on the right, without wheezing. On Rg-mm: infiltration S4-S10, AT S4-S5. Laboratory - moderate leukocytosis. Sick 11 days before hospitalization, low-grade fever for 5 days, cough. X-ray on the 5th day of the disease revealed infiltrative changes, AT detected on the 8th day of the disease.

 Treatment: two courses of antibiotics, aminophylline - 5 mg / kg per day, FTP, exercise therapy, massage. Two PBS were performed (at the first PBS, CT was not administered due to the pronounced inflammatory activity of the wall of the supply bronchus). After the first FBS, radiological AT was unchanged. Three days after the first PBS, during the second PBS, bolus selectively introduced into the AT zone 100 mg of Surfactant-HL in a volume of 5.0 ml of RF. Subjectively, the next day after the administration of CT, a pronounced detoxification effect is noted: the DN and severity of the condition decreased, weakness decreased, appetite appeared, the child became more mobile and cheerful. On Rg-mma, 4 days after the administration of CT, the full resolution of AT and the clinical and radiological resolution of pneumonia are shown.

 Result: the patient received 100 mg of CT and 4 days after its administration, AT disappeared, the child was discharged home after 2 days.

 Example 3

 Girl Daria P. 3.5 years, N East. b. 13617, was treated in the XI Department of Children's Hospital No 19 from 11/23/98 to 12/10/98 with a diagnosis of acute focal-confluent right-sided (S6-S10) bronchopneumonia, DN-1. Complication - AT S7 of the right lung, reactive pleurisy. Upon admission, the condition is satisfactory, without a pronounced intoxication syndrome. Mosaic percussion sound above the lower lobe on the right, hard breathing, dry and small wet rales. On Rg-mm: focal infiltration, AT S7. Laboratory - without signs of paraclinical activity. The girl is sick 25 days before admission to the clinic. The disease began with acute respiratory viral infection (ARVI), persistent coughing appeared on day 4 of the disease, and AT was detected on day 19 of the disease on Rg-mm of the chest.

 Treatment: two courses of antibiotics, aminophylline - 7 mg / kg per day, FTP, exercise therapy, massage. Two FBSs were performed (at the first FBS - the 27th day of illness, CT was not administered due to the pronounced inflammatory activity of the wall of the supply bronchus). 3 days after the first FBS, radiological AT was unchanged. During the second FBS, bolus selectively introduced into the AT zone 100 mg of Surfactant-HL in a volume of 5.0 ml of RF. When Rg-control after 3 days, the full resolution of AT and clinical and radiological resolution of pneumonia.

 Result: the patient received 100 mg of CT, 3 days after its administration, AT disappeared and the child was discharged home.

 Example No. 4.

 Anna S. 12 years, East. b. N 12777, was treated in the XI Department of Children's Hospital No 19 from 11/04/98 to 12/09/98 with a diagnosis of acute segmental, left-sided (S4-S5) bronchopneumonia, DN-II. Complication - AT S4-S5 of the left lung. Upon admission - a moderate condition, with severe symptoms of intoxication, weakening of breathing over the reed segments, creeping rales. X-ray - unilateral pneumonic infiltration with AT left S4-S5. Laboratory - moderate leukocytosis.

The girl is sick for a week before admission to the department, beginning with febrile fever (t - 38.9 ^o C), increasing cough. On the Rg-mm of the chest on the 7th day of the disease, AT was detected.

 Treatment: three courses of antibiotics, aminophylline - 5 mg / kg per day, FTP, exercise therapy, massage. Three FBSs were performed on the 9th, 12th and 14th day of the disease with 150, 200 and 300 mg of Surfactant-BL, respectively. After two PBS with the introduction of CT - a positive trend, but continued to decrease lung volume. After the third administration of CT, the full resolution of AT. In total, the girl received 650 mg of surfactant with the help of three FBS, AT was resolved on day 16 and the next day the child was discharged home.

 Example 5

Alexander Sh. Ist. b. N 11669, was treated in the XI Department of Children's Hospital No 19 from 10/12/98 to 11/20/98 with a diagnosis of acute foci, right-sided (S4-S5) bronchopneumonia, prolonged course, DN-1. Complication - AT S4-S5 of the right lung. Upon admission - a moderate condition, with moderate intoxication. On examination: shortening S4-S5, weakening of breathing over the middle lobe without wheezing. Radiological - one-sided pneumonic infiltration with AT S4-S5 on the right. Laboratory - moderate leukocytosis, eosinophilia, sharply accelerated ROE - 52 mm / hour. Sick 25 days before admission to the hospital, the beginning with acute respiratory viral infections, rhinitis, tracheitis, on the 10th day of illness, the temperature rises to 39 ^o C, which lasted for 4 days. On Rg-mm of the chest, AT was detected on day 25 of the disease.

 Treatment: three courses of antibiotics, aminophylline - 8 mg / kg per day, FTL, exercise therapy, massage. Conducted a traditional treatment with two rehabilitation FBS without the introduction of CT. Due to the complete lack of dynamics in the AT resolution, three more FBS were performed on the 35th, 38th and 41st days of the disease, 150 mg of Surfactant-BL for each FBS. There was a pronounced positive trend, but AT was not completely resolved and the child was discharged home. Monitoring the dynamics of AT one month after hospitalization - full resolution AT.

 To date, the proposed method has treated 26 children with acute bronchopneumonia complicated by atelectasis.

 The proposed method in comparison with the known has several significant advantages.

 1. The method allows to significantly increase the full resolution of atelectasis. In our studies, in the treatment of 26 children aged 9 months to 14 years, full AT resolution was found in 19 (73%), while in the control (K) group of 30 children who received traditional treatment using rehabilitation PBS without CT, only 17 children (57%) showed full AT resolution.

 2. The method allows to significantly increase the effectiveness of AT treatment (total number of children who have full or partial AT resolution). In our observations, in 24 children (19 full and 5 partial AT resolution) out of 26, a positive effect was obtained (92%), while in the K group of 30 children only 21 (70%) had a positive effect.

 3. The method allows to significantly reduce the number of ongoing rehabilitation FBS. In the group of children receiving ST, the number of PBS was 1.67 ± 0.29, and in the group K 3.17 ± 0.36. Such a significant reduction in the number of FBS for the resolution of AT is extremely important, since it significantly reduces the hospitalization time and the number of indifferent traumatic procedures that are used in treatment. It should be recalled that up to 10 years old children undergo FBS under general anesthesia.

 4. The method allows to significantly increase the number of permitted AT with a long life. In our observations, there were 5 children in whom the AT existed for 30 to 45 days. 4 of them received full permission and 1 - partial. In addition, we applied the method in the treatment of 3 children (in addition to 26 children) in whom AT persisted for 80 to 90 days. Only one of them experienced a partial decrease in AT area.

 5. The method can significantly reduce the time of inpatient treatment of patients with acute obstructive obstructive obstruction. Reducing the number of PBS on average from 4-5 to 1-2 already gives a reduction in the duration of inpatient treatment by 7-15 days. Such a reduction in treatment time also reduces the number of courses of antibiotic therapy - an indifferent and not cheap component of the treatment of OBP.

 6. The method significantly reduces the number of children in whom AT, which occurs as a complication of OBN, becomes chronic, leads to the formation of bronchiectasis and requires further surgical treatment.

 7. An important advantage of the proposed method is the use of Surfactant-HL and Surfactant-BL preparations - natural pulmonary surfactants containing 89% - 93.8% phospholipids, 4.2% - 9% neutral lipids and characterized by a high content of surfactant-associated proteins - 2 , 0%.

 Due to this composition of surfactant preparations, the method has a general detoxifying effect and has a positive effect on the severity of the general condition of patients and the favorable outcome of not only AT treatment, but also the outcome of OBN itself. As can be seen from the above examples and analysis of the results of treatment for all 26 children, the terms for resolving OBP when using ST are significantly reduced. This is certainly related to the indirect effects of natural surfactant preparations containing a larger (large) amount of surfactant-associated proteins.

 The method was developed by employees of the Central Scientific Research X-ray Radiological Institute of the Ministry of Health of the Russian Federation and employees of the XI department (department of infectious pulmonology) of the Children's City Hospital (Children's Hospital) N 19 named after K.A. Raukhfusa (St. Petersburg). He underwent clinical testing in the treatment of 26 children with acute bronchopneumonia complicated by atelectasis with positive results.

LIST OF REFERENCES
1. Klimanskaya E.V. The basics of pediatric bronchology. Moscow, "Medicine", 1972, p. 173.

 2. Savelyev B.C., Buyanov V.M., Lukomsky G.I. Clinical Endoscopy Guide. Moscow, "Medicine", 1985, p. 543.

 3. Zelinskaya D.I., Bayburina A.T., Karpeeva E.E. et al. Collection: Maternal and Child Health Service in 1997, Moscow, 1997, Ed. Ministry of Health of the Russian Federation.

 4. Rachinsky S.V., Tatochenko V.K. Respiratory diseases in children. Moscow, "Medicine", 1987, p. 494.

 5. Holliday H.L. Natural vs synthetic surfactants in neonatal respiratory distress syndrome (Review). // Drugs, 1966.- V. -51, N 2. P.- 226 - 237.

 6. Rosenberg O. A., Shaldzhyan A.A., Suiliev A.A. et al. A method for producing pulmonary surfactant. 1995 (priority), 1996 (per) N 2066197. Bulletin of inventions N 25, 1996.

 7. Rosenberg O. A., Shaldzhyan A.A., Suiliev A.A. et al. A method for producing pulmonary surfactant. 1995 (priority), 1996 (per) N 2066198. Bulletin of inventions N 25, 1996.

 8. Boncuk-Dayaniki P., Taeusch H.W. Essential and nonessential constituents of exogenic surfactants. Surfactant Therapy for Lung Disease. Ed. Robertson B. and Taeusch H.W.- N.Y., 1995 .-- P. 217-238.

 9. Knoch M; Heoltermann W; Lukasewitz P; Bittersohl J. Treatment of total atelectasis of the left lung in severe ARDS with side-separated ventilation and surfactant administration.// Anasthesiol Intensivmed Notfallmed Schmerzther. 1996. V. - 31, N 4. P.-270-273.

 10. Hoheisel G; Moche M; Borte g; Bilek K; Schauer J; Engelmann L. Surfactant administration and laterally independent positive pressure ventilation in acute lung failure and atelectasis after septic abortion. Case report.// Pneumologie, 1997. V.- 51, - N 3. P.-270-273.

 11. Tsybulkin E.K., Rosenberg O.A., Seiliev A.A. et al. The experience of using a domestic pulmonary surfactant preparation for the treatment of respiratory distress syndrome in adults and severe pneumonia in children. // Anesthesiology and Intensive Care. 1999.- N 2.S.- 61-65.

 12. Yu.A. Kirillov, V. F. Dubrovskaya, A. A. Seiliev and others. The effect of surfactant of lung cattle on bleomycin-induced pathology of rat lungs. Pulmonology, 1998, N 3, p. 51 - 55.

 13. Schurch S., Bachofen H. Biophysical aspects in the design of a therapeutic surfactant.//In: Surfactant Therapy for Lung Disease. Ed. Robertson B. and Taeusch H.W.- N.Y., 1995 .-- P. 3 - 29.

 14. Gunter A., Seeger W. Resistance to surfactant inactivation. In: Surfactant Therapy for Lung Disease. Ed. Robertson B. and Taeusch H.W.- N.Y. , 1995 .-- P. 269-292.

 15. van Iwaarden J.F., van Golde L.M.G. Pulmonary surfactant and lung defense. In: Surfactant Therapy for Lung Disease. Ed. Robertson B. and Taeusch H.W., N.Y., 1995 .-- P. 75-92.

 16. Pison U., Bock J.C., Pietschmann S., Veit S., Slama K. The adult respiratory distress syndrome: pathophysiological concepts related to the pulmonary surfactant system.//.In: Surfactant Therapy for Lung Disease. - N. Y., 1995 .-- P. 169-198.

 17. Suwabe A, Otake K, Yakuwa N. et al. Artificial surfactant (Surfactant-TA) modulates adherence and superoxide production of neutrophils. Am J Respir Crit Care Med, 1998. V.-158, N 6. P.- 1890-1899.

 18. McCormack F.X., Mason R.J. Surfactant therapy in adult respiratory distress syndrome. // In: Surfactant Therapy for Lung Disease. - N.Y., 1995 .-- P. 573-600.

 19. Willson D. F., Jiao J.H., Bauman L.A. et al. Calf's lung surfactant extract in acute hypoxemic respiratory failure in children.// Crit. Care Med. 1996. V. 24, N -8. P.- 1316 - 1322.

Claims (2)

 1. A method of treating acute bronchopneumonia complicated by atelectasis in children by selective debridement bronchoscopy and the administration of surfactant-BL, characterized in that in the presence of atelectasis as a complication of acute bronchopneumonia, surfactant-BL is administered once or 2–3 times bolus at intervals of 2 to 3 days at a dose of 100 - 300 mg per administration.  2. The method according to claim 1, characterized in that the repeated administration after 2 to 3 days is carried out when a pronounced inflammation of the bronchial wall is detected.

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