[Lung lavage and artificial surfactant replacement therapy--animal experimentation and clinical application]

Lung lavage may cause a surfactant deficient condition. We examined the effect of artificial surfactant replacement on the post-lavage condition in rabbits and in a patient with alveolar pulmonary proteinosis. Adult rabbits (n = 21) were subjected to whole-lung lavage, and the PaO2 was made to decrease to less than 70 mmHg (FIO2 = 1.0). In the replaced group (n = 11), an artificial surfactant which was a saline suspension of lipids (mixture of dipalmitoylphosphatidylcholine, phosphatidylglycerol and tripalmitin) was administered into the airway. The PaO2 was elevated to a level higher than 400 mmHg at 30 min after the surfactant replacement. On the other hand, the PaO2 in the non-replaced group (n = 10) remained below 100 mmHg. In the patient with alveolar pulmonary proteinosis, we performed the artificial surfactant replacement after the therapeutic lung lavage. By the replacement, the PaO2 increased from 89 mmHg (FIO2 = 1.0) to 128 mmHg. These results demonstrate the therapeutic effects of surfactant replacement on the acute respiratory failure induced by lung lavage.