title: Lavage administration of dilute surfactant in a piglet model of meconium aspiration.
abstract: Maldistribution of exogenous surfactant may preclude any clinical response in acute lung injury associated with surfactant dysfunction. Our previous studies have shown the effectiveness of surfactant lavage after homogenous lung injury. The present study utilizes a histologically confirmed non-homogeneous lung injury model induced by saline lung-lavage followed by meconium injected into a mainstem bronchus. Piglets were then treated with Infasurf or Exosurf by lavage (I-LAVAGE, n = 7; E-LAVAGE, n = 5) or bolus (I-BOLUS, n = 8; E-BOLUS, n = 5), or went untreated (CONTROL, n = 4). Lavage administration utilized a dilute surfactant (35 ml/kg; 4 mg phospholipid/ml) instilled into the lung, followed by gravity drainage. The retained doses of the respective surfactant in the lavage and bolus groups were similar. Results showed that the surfactant distribution was more uniform in the lavage groups compared to the bolus groups. Significant and consistent increases in PaO2 were observed in the lavage groups compared to the bolus groups and the controls. PaO2 (mmHg) at 240 min posttreatment: I-LAVAGE = 297 +/- 54, E-LAVAGE = 280 +/- 57; I-BOLUS = 139 +/- 31; E-BOLUS = 152 +/- 29; C = 119 +/- 73 (mean +/- SEM). Other improved pulmonary function parameters favored lavage administration. We conclude that better surfactant distribution achieved by lavage administration can be more effective than bolus administration in this type of non-homogeneous lung injury.
authors.affiliation: Clinical Research Center and Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii and Kapiolani Medical Center for Women and Children, Honolulu, Hawaii 96826, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Meister
authors.forename: Venkataraman
authors.initials: V
authors.lastname: Balaraman
authors.forename: Malia
authors.initials: M
authors.lastname: Ramirez
authors.forename: Catherine F T
authors.initials: CF
authors.lastname: Uyehara
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Killeen
authors.forename: Tercia
authors.initials: T
authors.lastname: Ku
authors.forename: Donald
authors.initials: D
authors.lastname: Person
authors.forename: David
authors.initials: D
authors.lastname: Easa
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000187:drug effects / Q000473:pathology; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000188:drug therapy* / Q000473:pathology; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012996:Solutions; D013552:Swine; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants; D012996:Solutions