MD Henry, CM Rebello, M Ikegami, AH Jobe, EG Langenback and JM Davis
Department of Pediatrics, Harbor-UCLA Medical Center, Torrance 90502, USA.

To evaluate the efficiency and distribution of ultrasonic nebulized versus instilled surfactant in the treatment of surfactant deficiency at varying degrees of maturation, twin or triplet lamb fetuses were delivered at 125 to 137 d gestational age and received nebulized natural surfactant (Neb Only), instilled surfactant followed by a second instilled dose (Inst/Inst), instilled surfactant followed by nebulized surfactant (Inst/Neb), or no surfactant (Control). The lambs were ventilated for 6 h. Twenty-eight lambs were categorized into two groups (low compliance versus moderate compliance) based on initial physiologic lung characteristics. Efficiency of deposition of nebulized surfactant directly correlated with the compliances and ventilatory efficiency indices measured at 15 min of age. The low-compliance group (Low Comp) had significantly lower efficiency of surfactant deposition (7.6 +/- 1.6%) than did the moderate-compliance group (Mod Comp) (23.4 +/- 2.5%) (p < 0.01). Overall, instilled surfactant had a reasonably homogeneous distribution, whereas nebulized surfactant had a less homogeneous distribution, except for the Low Comp, Inst/Neb group, which had a distribution pattern similar to that for instilled surfactant. The potential for nebulized surfactant therapy for respiratory distress syndrome (RDS) may be limited by the nonhomogeneous nature of ventilation in the preterm lung.

This article has been cited by other articles:

				R. T. Schermuly, A. Gunther, M. Ermert, L. Ermert, H. A. Ghofrani, N. Weissmann, F. Grimminger, W. Seeger, and D. Walmrath Conebulization of surfactant and urokinase restores gas exchange in perfused lungs with alveolar fibrin formation Am J Physiol Lung Cell Mol Physiol, April 1, 2001; 280(4): L792 - L800. [Abstract] [Full Text] [PDF]

				R. T. SCHERMULY, A. GÜNTHER, N. WEISSMANN, H. A. GHOFRANI, W. SEEGER, F. GRIMMINGER, and D. WALMRATH Differential Impact of Ultrasonically Nebulized Versus Tracheal-instilled Surfactant on Ventilation-Perfusion (VA/Q) Mismatch in a Model of Acute Lung Injury Am. J. Respir. Crit. Care Med., January 1, 2000; 161(1): 152 - 159. [Abstract] [Full Text]

				V. BALARAMAN, J. MEISTER, T. L. KU, S. L. SOOD, E. TAM, J. KILLEEN, C. F. T. UYEHARA, E. EGAN, and D. EASA Lavage Administration of Dilute Surfactants after Acute Lung Injury in Neonatal Piglets Am. J. Respir. Crit. Care Med., July 1, 1998; 158(1): 12 - 17. [Abstract] [Full Text] [PDF]

				R. SCHERMULY, T. SCHMEHL, A. GÜNTHER, F. GRIMMINGER, W. SEEGER, and D. WALMRATH Ultrasonic Nebulization for Efficient Delivery of Surfactant in a Model of Acute Lung Injury . Impact on Gas Exchange Am. J. Respir. Crit. Care Med., July 1, 1997; 156(2): 445 - 453. [Abstract] [Full Text]