Response to exogenous surfactant is different during open lung and conventional ventilation.
OBJECTIVE
Previous studies have shown that the efficacy of exogenous surfactant is dose-dependent during conventional positive pressure ventilation (PPVCON). The present study aimed to determine whether this dose-dependent relationship is also present during open lung (OLC) ventilation. We also explored the effect of exogenous surfactant on the ventilation pressures applied during ventilation.


METHODS
Animal study.


METHODS
University-affiliated research laboratory.


METHODS
Seventy-two newborn piglets.


METHODS
After repeated whole lung lavage, animals were randomly allocated to two surfactant groups receiving either 100 mg/kg surfactant (S100) or 25 mg/kg surfactant (S25) or to a control group receiving a bolus of air. Within each group, animals were randomly assigned to either PPVCON, open lung PPV (PPVOLC), or open lung high-frequency oscillatory ventilation (HFOVOLC) and ventilated for 5 hrs.


RESULTS
The ventilation pressures decreased in a dose-dependent way, showing the largest reduction in the S100 group. In both OLC groups, oxygenation, lung mechanics, and polymorphonuclear neutrophils analyzed in bronchoalveolar lavage were independent of the surfactant dose. In the PPVCON group, however, there was a clear dose-dependency, resulting in a deterioration of oxygenation and lung mechanics and an increase in polymorphonuclear neutrophils as the surfactant dose decreased. Although comparable between the three ventilation groups, bronchoalveolar lavage interleukin-8 concentrations significantly increased in all ventilation groups as the surfactant dose increased. Alveolar protein influx and conversion of large to small aggregate surfactant were higher during PPVCON compared with both OLC groups. There were no differences in the surfactant treatment response between PPVOLC and HFOVOLC.


CONCLUSIONS
Exogenous surfactant enables a reduction in ventilation pressures. Compared with PPVCON, the efficacy of surfactant treatment is less dose-dependent during open lung ventilation. Surfactant conversion during open lung ventilation is reduced compared with PPVCON. Exogenous surfactant seems to up-regulate bronchoalveolar lavage interleukin-8 concentrations, independent of the ventilation strategy.
van Kaam
Anton H
AH
Department of Anesthesiology, Erasmus-MC Faculty, Rotterdam, The Netherlands.
Haitsma
Jack J
JJ
Dik
Willem A
WA
Naber
Birgitta A
BA
Alblas
Elise H
EH
De Jaegere
Anne
A
Kok
Joke H
JH
Lachmann
Burkhard
B
D000704:Analysis of Variance; D000818:Animals; D000831:Animals, Newborn; D004305:Dose-Response Relationship, Drug; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D011663:Pulmonary Surfactants / Q000494:pharmacology* / Q000627:therapeutic use; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000628:therapy; D015656:Respiratory Mechanics / Q000187:drug effects*; D013552:Swine
D011663:Pulmonary Surfactants