title: Lung volume recruitment after surfactant administration modifies spatial distribution of ventilation.
abstract: BACKGROUND
  Although surfactant replacement therapy is an established treatment in infant respiratory distress syndrome, the optimum strategy for ventilatory management before, during, and after surfactant instillation remains to be elucidated.
  
  
  OBJECTIVE
  To determine the effects of surfactant and lung volume recruitment on the distribution of regional lung ventilation.
  
  
  METHODS
  Acute lung injury was induced in 16 newborn piglets by endotracheal lavage. Optimum positive end-expiratory pressure was identified after lung recruitment and surfactant was administered either at this pressure in the "open" lung or after disconnection of the endotracheal tube in the "closed" lung. An additional recruitment maneuver with subsequent optimum end-expiratory pressure finding was executed in eight animals; in the remaining eight animals, end-expiratory pressure was set at the same level as before surfactant without further recruitment. ("Open" and "closed" lung surfactant administration was evenly distributed in the groups.) Regional ventilation was assessed by electrical impedance tomography.
  
  
  RESULTS
  Impedance tomography data, airway pressure, flow, and arterial blood gases were acquired during baseline conditions, after induction of lung injury, after the first lung recruitment, and before as well as 10 and 60 min after surfactant administration. Significant shift in ventilation toward the dependent lung regions and less asymmetry in the right-to-left lung ventilation distribution occurred in the postsurfactant period when an additional recruitment maneuver was performed. Surfactant instillation in an "open" versus "closed" lung did not influence ventilation distribution in a major way.
  
  
  CONCLUSIONS
  The spatial distribution of ventilation in the lavaged lung is modified by a recruitment maneuver performed after surfactant administration.
authors.affiliation: Department of Anesthesiological Research, University of Göttingen, Germany. frerichs@anaesthesie.uni-kiel.de
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs
authors.forename: Peter A
authors.initials: PA
authors.lastname: Dargaville
authors.forename: Huibert
authors.initials: H
authors.lastname: van Genderingen
authors.forename: Denis R
authors.initials: DR
authors.lastname: Morel
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rimensberger
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001784:Blood Gas Analysis; D004195:Disease Models, Animal; D017097:Electric Impedance; D007322:Instillation, Drug; D008168:Lung / Q000187:drug effects* / Q000502:physiology; D011663:Pulmonary Surfactants / Q000494:pharmacology*; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000187:drug effects* / Q000502:physiology; D013552:Swine
chemical_list: D011663:Pulmonary Surfactants