Treatment of ventilation-induced lung injury with exogenous surfactant.
OBJECTIVE
It has been demonstrated that pulmonary surfactant plays a role in the pathophysiology of ventilation-induced lung injury (VILI). Therefore, we investigated whether exogenous surfactant might restore lung function and lung mechanics in an established model of VILI.


METHODS
Prospective, randomized, animal study.


METHODS
Experimental laboratory of a university.


METHODS
Twenty-four adult male Sprague-Dawley rats.


METHODS
First, a group of six animals were killed immediately after induction of anesthesia and used as healthy controls. Then, in 18 rats, VILI was induced by increasing peak inspiratory pressure (PIP) to 45 cmH2O without positive end-expiratory pressure (PEEP) for 20 min. Thereafter, animals were randomly divided into three groups of six animals each: one group was killed immediately after VILI and served as VILI-control. In the other two groups, ventilator settings were changed to a PIP of 30 cmH2O and a PEEP of 10 cmH2O, and a respiratory rate of 40 bpm. One group received a bolus of surfactant and the other group received no treatment.


RESULTS
Blood gas tension and arterial blood pressures were recorded every 30 min for 2 h. After the study period, a pressure-volume curve was recorded. Then, a broncho-alveolar lavage (BAL) was performed to determine protein content, minimal surface tension, and surfactant composition in the BAL fluid. Oxygenation, lung mechanics, surfactant function and composition were significantly improved in the surfactant-treated group compared to the ventilated and non-ventilated control groups.


CONCLUSIONS
We conclude that exogenous surfactant can be used to treat VILI.
Vazquez de Anda
G F
GF
Department of Anesthesiology, (Room Ee 2393), Erasmus University Rotterdam, P.O. Box 1738, 3000 Rotterdam, The Netherlands.
Lachmann
R A
RA
Gommers
D
D
Verbrugge
S J
SJ
Haitsma
J
J
Lachmann
B
B
D000818:Animals; D001784:Blood Gas Analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D008176:Lung Volume Measurements; D008297:Male; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011663:Pulmonary Surfactants / Q000494:pharmacology / Q000627:therapeutic use*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D015656:Respiratory Mechanics / Q000187:drug effects
D011663:Pulmonary Surfactants