Pre- versus post-ventilatory surfactant treatment in surfactant-deficient preterm lambs

Twenty lambs at 127 days' gestation (term is 145 days) were randomly assigned to receive Infasurf (Calf Lung Surfactant Extract, ONY Inc., Amherst, NY) as an intratracheal bolus (3 mliter kg-1) either into a fluid-filled lung before ventilation (n = 10), or after ventilation for 5 min (n = 10). All lambs were surfactant-deficient by analysis of lung liquid obtained before surfactant administration. Lambs were then mechanically ventilated for 4 h. Oxygenation for the lambs given surfactant before ventilation did not change during the experiment; a/A pO2 was 0.50 +/- 0.13 at 1 h and 0.52 +/- 0.17 at 4 h. For the lambs given surfactant after initial ventilation, oxygenation decreased over time; a/A pO2 decreased from 0.48 +/- 0.23 at 1 h to 0.37 +/- 0.22 at 4 h (P < 0.05). Compliance, as calculated from the Ventilator Efficiency Index (VEI), improved over time in both groups, but was always significantly higher for lambs given surfactant before ventilation (P = 0.03). Histologic examination of the lungs revealed no differences between the groups; no evidence of epithelial denudation or hyaline membrane formation was seen in either group. Thus, ventilation of surfactant-deficient newborn lambs for 5 min before surfactant administration results in significantly decreased lung function when compared with surfactant administration before ventilation. These differences in lung function are not dependent on a histopathologic injury to the lung. It is possible that unevenness of deposition of the surfactant in an air-filled lung, compared to more uniform deposition in a fluid-filled unventilated lung, produces these differences.