title: Surfactant replacement and open lung concept--comparison of two treatment strategies in an experimental model of neonatal ARDS.
abstract: BACKGROUND
  Several concepts of treatment in neonatal ARDS have been proposed in the last years. The present study compared the effects of open lung concept positive pressure ventilation (PPVOLC) with a conventional ventilation strategy combined with administration of two different surfactant preparations on lung function and surfactant homoeostasis.
  
  
  METHODS
  After repeated whole-lung saline lavage, 16 newborn piglets were assigned to either PPVOLC (n = 5) or surfactant treatment under conventional PPV using a natural bovine (n = 5) or a monomeric protein B based surfactant (n = 6).
  
  
  RESULTS
  Comprehensive monitoring showed each treatment strategy to improve gas exchange and lung function, although the effect on PaO2 and pulmonary compliance declined over the study period in the surfactant groups. The overall improvement of the ventilation efficiency index (VEI) was significantly greater in the PPVOLC group. Phospholipid and protein analyses of the bronchoalveolar lavage fluid showed significant alterations to surfactant homoeostasis in the PPVOLC group, whereas IL-10 and SP-C mRNA expression was tendentially increased in the surfactant groups.
  
  
  CONCLUSIONS
  The different treatment strategies applied could be shown to improve gas exchange and lung function in neonatal ARDS. To which extent differences in maintenance of lung function and surfactant homeostasis may lead to long-term consequences needs to be studied further.
authors.affiliation: Dept of Pediatrics and Neonatology, University of Giessen and Marburg, Germany. anne.hilgendorff@med.uni-muenchen.de
authors.forename: Anne
authors.initials: A
authors.lastname: Hilgendorff
authors.forename: Ece
authors.initials: E
authors.lastname: Aslan
authors.forename: Thomas
authors.initials: T
authors.lastname: Schaible
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.forename: Thorsten
authors.initials: T
authors.lastname: Baehner
authors.forename: Michael
authors.initials: M
authors.lastname: Ebsen
authors.forename: Jochen
authors.initials: J
authors.lastname: Kreuder
authors.forename: Clemens
authors.initials: C
authors.lastname: Ruppert
authors.forename: Andreas
authors.initials: A
authors.lastname: Guenther
authors.forename: Irwin
authors.initials: I
authors.lastname: Reiss
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D002417:Cattle; D004195:Disease Models, Animal; D006706:Homeostasis; D006801:Humans; D007231:Infant, Newborn; D016753:Interleukin-10 / Q000378:metabolism; D007378:Interleukins / Q000235:genetics; D008168:Lung / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008170:Lung Compliance; D010100:Oxygen; D010313:Partial Pressure; D010743:Phospholipids / Q000378:metabolism; D011175:Positive-Pressure Respiration; D011659:Pulmonary Gas Exchange; D037701:Pulmonary Surfactant-Associated Protein B / Q000235:genetics; D037721:Pulmonary Surfactant-Associated Protein C / Q000235:genetics; D037661:Pulmonary Surfactant-Associated Proteins / Q000378:metabolism; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012333:RNA, Messenger / Q000378:metabolism; D012119:Respiration; D012127:Respiratory Distress Syndrome, Newborn / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D015854:Up-Regulation
chemical_list: D007378:Interleukins; D010743:Phospholipids; D037701:Pulmonary Surfactant-Associated Protein B; D037721:Pulmonary Surfactant-Associated Protein C; D037661:Pulmonary Surfactant-Associated Proteins; D011663:Pulmonary Surfactants; D012333:RNA, Messenger; D016753:Interleukin-10; D010100:Oxygen