Immediate effects on lung function of instilled human surfactant in mechanically ventilated newborn infants with IRDS

We have studied the effects on lung volume, respiratory mechanics and ventilation during the first hours after instillation of 60 mg/kg of human surfactant into the trachea of 4 very preterm, newborn infants with severe IRDS under mechanical ventilation. Measurements were made with a "face-out" body plethysmograph and a modified nitrogen wash-out method. In addition to a transient decrease in total and alveolar ventilation immediately after the instillation we found an immediate rise in lung volume, but respiratory compliance decreased. These changes lasted less than two hours. Oxygen requirements fell in 3 out of 4 infants. The changes in lung volume and compliance are explained in terms of changes in the shape of the static recoil pressure characteristics of the diseased lungs after treatment. Mechanisms behind the short duration are sought in mode of instillation, dosage, age at treatment, and severity of disease.