Surfactant replacement and open lung concept--comparison of two treatment strategies in an experimental model of neonatal ARDS.
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.
Hilgendorff
Anne
A
Dept of Pediatrics and Neonatology, University of Giessen and Marburg, Germany. anne.hilgendorff@med.uni-muenchen.de
Aslan
Ece
E
Schaible
Thomas
T
Gortner
Ludwig
L
Baehner
Thorsten
T
Ebsen
Michael
M
Kreuder
Jochen
J
Ruppert
Clemens
C
Guenther
Andreas
A
Reiss
Irwin
I
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
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