title: Improved gas exchange and survival after KL-4 surfactant in newborn pigs with severe acute lung injury.
abstract: 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.
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, MN 55110,USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Zimmermann
authors.forename: Kari D
authors.initials: KD
authors.lastname: Roberts
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Lampland
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Meyers
authors.forename: Cathy T
authors.initials: CT
authors.lastname: Worwa
authors.forename: Brenda
authors.initials: B
authors.lastname: Plumm
authors.forename: M Cristina
authors.initials: MC
authors.lastname: Pacheco
authors.forename: Marla R
authors.initials: MR
authors.lastname: Wolfson
authors.forename: Mark C
authors.initials: MC
authors.lastname: Mammel
mesh_terms: 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
chemical_list: D036341:Intercellular Signaling Peptides and Proteins; C097558:KL4 surfactant; D010455:Peptides