The impact of surfactant replacement therapy on cerebral and systemic circulation and lung function.
The influence of surfactant administration on cerebral and systemic circulation and on lung function was evaluated in 12 premature mechanically ventilated infants (mean birth weight 1,560 +/- 770 g, mean gestational age 30.0 +/- 3.2 weeks) with respiratory distress syndrome (RDS) receiving surfactant replacement therapy. We measured mean cerebral blood flow velocity (MCBFV), heart rate (HR), mean arterial pressure (MAP), static compliance (Crs), resistance of respiratory system (Rrs), functional residual capacity (FRC) and fraction of inspired oxygen (FiO2). In addition to a very low compliance and a moderately elevated resistance of the respiratory system a significant drop in MAP, HR, MCBFV and FiO2 was noticed after surfactant administration. After 30 min HR, MAP and MCBFV values returned to baseline levels. We postulate that the drop in MCBFV, MAP, HR and FiO2 with a minor, though not significant improvement of the FRC can most likely be explained by a "relative" hypovolaemia in other organs and parts of the body due to expansion of the lung vascular bed. Compensation for the redistribution of circulatory volume occurred within several minutes. Blood pressure control and treatment of hypovolaemia is mandatory before surfactant is administered.


CONCLUSIONS
In RDS patients there is a significant drop of MAP, HR, MCBFV and FiO2 after bolus surfactant administration.
Schipper
J A
JA
Department of Neonatology, Academic Medical Centre/University of Amsterdam, The Netherlands.
Mohammad
G I
GI
van Straaten
H L
HL
Koppe
J G
JG
D000403:Airway Resistance / Q000187:drug effects* / Q000502:physiology; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D005260:Female; D005652:Functional Residual Capacity / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000097:blood*; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000009:adverse effects; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D011663:Pulmonary Surfactants; D010100:Oxygen