V. Balaraman et al., PHYSIOLOGICAL-RESPONSE AND LUNG DISTRIBUTION OF LAVAGE VERSUS BOLUS EXOSURF(R) IN PIGLETS WITH ACUTE LUNG INJURY, American journal of respiratory and critical care medicine, 153(6), 1996, pp. 1838-1843
Citations number
34
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
Despite evidence of surfactant dysfunction in the acute respiratory di
stress syndrome (ARDS), treatment with exogenous surfactant remains ex
perimental. Uneven pulmonary distribution is one factor that may limit
response. We investigated whether exogenous surfactant administered b
y lavage, consisting of a 35 ml/kg volume instilled by gravity and fol
lowed immediately by passive drainage (LAVAGE), would result in better
lung distribution and physiologic response than with surfactant admin
istered as a 5 ml/kg bolus (BOLUS). Exosurf(R), an artificial surfacta
nt, was administered after acute lung injury induced by saline lung la
vage in neonatal piglets. In the LAVAGE group (n = 9), 10.1 +/- 0.4 ml
/kg of surfactant was retained, corresponding to a phospholipid dose o
f 136 +/- 5 mg/kg. In the BOLUS group (n = 9), the dose administered w
as 203 mg/kg phospholipid. Piglets in the LAVAGE group demonstrated gr
eater improvement in pulmonary function, including Pa-O2, Pa-CO2, vent
ilation efficiency index, functional residual capacity (FRC), and pres
sure-volume curves than piglets in the BOLUS group. Some differences w
ere found in lung distribution of surfactant. We conclude that Exosurf
is more effective when administered by lavage in this lung injury mod
el. We speculate that the lavage method of administration holds promis
e as an alternative method of surfactant administration in patients wi
th ARDS.