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Exogenous surfactant and partial liquid ventilation: physiologic and pathologic effects

J D Mrozek1, K M Smith, D R Bing

  • 1Infant Pulmonary Research Center, Children's Health Care-St. Paul, Minnesota 55102, USA.

American Journal of Respiratory and Critical Care Medicine
|November 14, 1997
PubMed
Summary
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Surfactant therapy combined with partial liquid ventilation (PLV) significantly improved oxygenation and lung mechanics in an animal model. Administering surfactant before PLV yielded the best results for lung pathology.

Area of Science:

  • Pulmonary Medicine
  • Critical Care Medicine
  • Respiratory Physiology

Background:

  • Acute lung injury (ALI) models are crucial for evaluating novel therapeutic strategies.
  • Surfactant replacement therapy and partial liquid ventilation (PLV) are potential treatments for ALI.
  • The optimal administration order of surfactant and PLV remains to be elucidated.

Purpose of the Study:

  • To compare the efficacy of surfactant therapy and PLV, individually and in combination, in an animal model of lung injury.
  • To investigate the impact of the administration order of surfactant and PLV on physiological and pathological outcomes.
  • To assess the effects on oxygenation, respiratory system compliance (Crs), hemodynamics, and lung pathology.

Main Methods:

  • Four groups of animals with induced lung injury were studied: surfactant alone (S), PLV alone (PLV-only), surfactant followed by PLV (S-PLV), and PLV followed by surfactant (PLV-S).

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  • Oxygenation index (OI), Crs, hemodynamics, and lung pathology were assessed post-treatment.
  • Statistical analysis was performed to compare outcomes between groups and administration orders.

    • Main Results:

    • All treatment groups showed improvements in OI and Crs compared to baseline.
    • PLV groups demonstrated sustained improvements in OI and Crs over 2 hours.
    • Surfactant administration before PLV significantly improved Crs and reduced lung injury pathology compared to surfactant alone or PLV alone. Hemodynamics remained stable across all groups.

    Conclusions:

    • Combination therapy with surfactant and PLV offers superior benefits for oxygenation, respiratory mechanics, and lung pathology in ALI compared to surfactant alone.
    • The order of administration is critical: surfactant preceding PLV leads to the most significant improvements in pathological outcomes.
    • PLV, particularly when combined with surfactant, shows promise in mitigating lung injury in critical care settings.