Computed tomography assessment of exogenous surfactant-induced lung reaeration in patients with acute lung injury.
BACKGROUND
Previous randomized trials failed to demonstrate a decrease in mortality of patients with acute lung injury treated by exogenous surfactant. The aim of this prospective randomized study was to evaluate the effects of exogenous porcine-derived surfactant on pulmonary reaeration and lung tissue in patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS).


METHODS
Twenty patients with ALI/ARDS were studied (10 treated by surfactant and 10 controls) in whom a spiral thoracic computed tomography scan was acquired before (baseline), 39 hours and 7 days after the first surfactant administration. In the surfactant group, 3 doses of porcine-derived lung surfactant (200 mg/kg/dose) were instilled in both lungs at 0, 12 and 36 hours. Each instillation was followed by recruitment maneuvers. Gas and tissue volumes were measured separately in poorly/nonaerated and normally aerated lung areas before and seven days after the first surfactant administration. Surfactant-induced lung reaeration was defined as an increase in gas volume in poorly/non-aerated lung areas between day seven and baseline compared to the control group.


RESULTS
At day seven, surfactant induced a significant increase in volume of gas in poorly/non-aerated lung areas (320 ± 125 ml versus 135 ± 161 ml in controls, P = 0.01) and a significant increase in volume of tissue in normally aerated lung areas (189 ± 179 ml versus -15 ± 105 ml in controls, P < 0.01). PaO2/FiO2 ratio was not different between the surfactant treated group and control group after surfactant replacement.


CONCLUSIONS
Intratracheal surfactant replacement induces a significant and prolonged lung reaeration. It also induces a significant increase in lung tissue in normally aerated lung areas, whose mechanisms remain to be elucidated.


BACKGROUND
NCT00742482.
Lu
Qin
Q
Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, UPMC Univ Paris 06, 47-83 boulevard de l'hôpital, 75013 Paris, France. qin.lu@psl.aphp.fr
Zhang
Mao
M
Girardi
Cassio
C
Bouhemad
Belaïd
B
Kesecioglu
Jozef
J
Rouby
Jean-Jacques
JJ
D055371:Acute Lung Injury / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011663:Pulmonary Surfactants