title: Physiologic response and lung distribution of lavage versus bolus Exosurf in piglets with acute lung injury.
abstract: Despite evidence of surfactant dysfunction in the acute respiratory distress syndrome (ARDS), treatment with exogenous surfactant remains experimental. Uneven pulmonary distribution is one factor that may limit response. We investigated whether exogenous surfactant administered by lavage, consisting of a 35 ml/kg volume instilled by gravity and followed immediately by passive drainage (LAVAGE), would result in better lung distribution and physiologic response than with surfactant administered as a 5 ml/kg bolus (BOLUS). Exosurf, an artificial surfactant, was administered after acute lung injury induced by saline lung lavage in neonatal piglets. In the LAVAGE group (n= 9), 10.1 +/- 0.4 ml/kg of surfactant was retained, corresponding to a phospholipid dose of 136 +/- 5 mg/kg. In the BOLUS group (n = 9), the dose administered was 203 mg/kg phospholipid. Piglets in the LAVAGE group demonstrated greater improvement in pulmonary function, including PaO2, PaCO2, ventilation efficiency index, functional residual capacity (FRC), and pressure-volume curves than piglets in the BOLUS group. Some differences were found in lung distribution of surfactant. We conclude that Exosurf is more effective when administered by lavage in this lung injury model. We speculate that the lavage method of administration holds promise as an alternative method of surfactant administration in patients with ARDS.
authors.affiliation: Department of Pediatrics, Kapiolani Medical Center for Women and Children, John A. Burns School of Medicine, Honolulu, Hawaii, USA.
authors.forename: V
authors.initials: V
authors.lastname: Balaraman
authors.forename: S L
authors.initials: SL
authors.lastname: Sood
authors.forename: K C
authors.initials: KC
authors.lastname: Finn
authors.forename: G
authors.initials: G
authors.lastname: Hashiro
authors.forename: C F
authors.initials: CF
authors.lastname: Uyehara
authors.forename: D
authors.initials: D
authors.lastname: Easa
mesh_terms: D000208:Acute Disease; D000818:Animals; D000831:Animals, Newborn; D004338:Drug Combinations; D005233:Fatty Alcohols / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D005260:Female; D007267:Injections; D008168:Lung / Q000378:metabolism / Q000503:physiopathology*; D055370:Lung Injury; D008297:Male; D010767:Phosphorylcholine; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology*; D013552:Swine; D007507:Therapeutic Irrigation; D013997:Time Factors; D014018:Tissue Distribution
chemical_list: D004338:Drug Combinations; D005233:Fatty Alcohols; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination