PULMONARY MECHANICS IN VENTILATED PRETERM INFANTS WITH RESPIRATORY-DISTRESS-SYNDROME AFTER EXOGENOUS SURFACTANT ADMINISTRATION - A COMPARISON BETWEEN 2 SURFACTANT PREPARATIONS
Ml. Choukroun et al., PULMONARY MECHANICS IN VENTILATED PRETERM INFANTS WITH RESPIRATORY-DISTRESS-SYNDROME AFTER EXOGENOUS SURFACTANT ADMINISTRATION - A COMPARISON BETWEEN 2 SURFACTANT PREPARATIONS, Pediatric pulmonology, 18(5), 1994, pp. 273-278
The effects of two surfactant preparations on lung mechanics have been
studied on 24 ventilated premature infants with respiratory distress
syndrome (RDS): 13 were given artificial surfactant (Exosurf Neonatal,
Burroughs-Wellcome) and II natural porcine surfactant (Curosurf, Labo
ratoire Serono France). Measurements of respiratory system compliance
(C-dyn, C-rs) and resistance (R(rs)) were performed immediately before
surfactant administration and repeated 6, 18, 24, 48, and 72 hours la
ter. With Exosurf treatment, 6 hours after surfactant administration i
nhaled O-2 concentration (F-102) could be lowered from (0.72 +/- 0.20,
to 0.62 +/- 0.33; P < 0.05), whereas C-rs did not change (0.37 mL/cmH
(2)O/kg, +/- 0.14 vs. 0.39 +/- 0.12, NS). After 24 hours and during th
e following days a significant increase in C-rs occurred (24 hours pos
t-Exosurf: 0.51 +/- 0.18, P < 0.05). With Curosurf treatment, the impr
ovement in oxygenation was greater and F-102 could be lowered much mor
e after 6 hours (from F-102 0.78 +/- 0.23 to 0.34 +/- 0.11, P < 0.01).
This was associated with an increase in C-rs (from 0.39 +/- 0.09 to 0
.59 +/- 0.17, P < 0.05). During the following days, C-rs was significa
ntly higher in the group treated with Curosurf. Resistance was not alt
ered by the type of surfactant preparation used except after 72 hours,
when R(rs) increased in the group treated with Exosurf. In conclusion
, Curosurf appears to be more effective than Exosurf with regard to im
mediate pulmonary changes in ventilator treated premature infants with
RDS. A rapid increase in C-rs after Curosurf treatment indicates that
recruitment of new functional areas of the lung is likely to be assoc
iated with a stabilization of small airways and alveolar units. (C) 19
94 Wiley-Liss, Inc.