Improved gas exchange and survival after KL-4 surfactant in newborn pigs with severe acute lung injury.
OBJECTIVE
To determine the effectiveness of artificial surfactant therapy using KL-4 surfactant in newborn pigs with hydrochloric acid (HCl)-induced acute lung injury (ALI).


METHODS
After induction of ALI via intratracheal HCl instillation, pigs were randomized to receive 5.8 ml/kg KL-4 surfactant or no surfactant prior to extubation to bubble CPAP.


METHODS
Clinical laboratory.


METHODS
Spontaneously breathing newborn pigs (<1 week of age).


METHODS
Treatment with KL-4 surfactant on bubble CPAP with PEEP of 6 cmH(2)O for 3.5 hr after extubation compared with controls.


METHODS
Physiologic parameters and arterial blood gases were measured every 15 min. At the conclusion of the study, the lungs were excised for the analysis of histopathology and morphometric data.


RESULTS
Pigs treated with KL-4 surfactant had arterial blood gases with less acidosis (P < 0.001), higher P(a)O(2) levels (P < 0.001), and lower P(a)CO(2) levels (P < 0.001). Pigs treated with KL-4 surfactant had improved survival compared with controls (6/12 KL-4, 2/12 control, P < 0.05). Postmortem morphometric data demonstrated that pigs treated with KL-4 surfactant had larger (P < 0.05) exchange units in the caudal-dorsal lung as compared to relatively atelectatic region in the control animals.


CONCLUSIONS
In newborn pigs with severe HCl-induced ALI, treatment with KL-4 surfactant resulted in improved respiratory parameters, less dependent atelectasis, and improved short-term survival.
Zimmermann
Anna M
AM
Department of Pediatrics, University of Minnesota, Minneapolis, MN 55110,USA.
Roberts
Kari D
KD
Lampland
Andrea L
AL
Meyers
Patricia A
PA
Worwa
Cathy T
CT
Plumm
Brenda
B
Pacheco
M Cristina
MC
Wolfson
Marla R
MR
Mammel
Mark C
MC
D000142:Acidosis, Respiratory / Q000188:drug therapy; D055371:Acute Lung Injury / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000818:Animals; D000831:Animals, Newborn; D001784:Blood Gas Analysis; D004195:Disease Models, Animal; D036341:Intercellular Signaling Peptides and Proteins; D010455:Peptides / Q000627:therapeutic use*; D011175:Positive-Pressure Respiration; D001261:Pulmonary Atelectasis / Q000188:drug therapy; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D012720:Severity of Illness Index; D013552:Swine
D036341:Intercellular Signaling Peptides and Proteins; C097558:KL4 surfactant; D010455:Peptides