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Am. J. Respir. Crit. Care Med., Volume 156, Number 2, August 1997, 445-453

Ultrasonic Nebulization for Efficient Delivery of Surfactant in a Model of Acute Lung Injury
Impact on Gas Exchange

R. SCHERMULY, T. SCHMEHL, A. GÜNTHER, F. GRIMMINGER, W. SEEGER, and D. WALMRATH

Department of Internal Medicine, Justus-Leibig University, Giessen, Germany

We investigated the effect of ultrasonic nebulization versus instillation of exogenous surfactant on gas exchange abnormalities provoked by detergent inhalation in perfused rabbit lungs. Ventilation-perfusion (V A/Q) distribution was assessed by the multiple inert gas elimination technique. For nebulization of natural bovine surfactant (AIveofact ®), an ultrasonic device was placed in line with the inspiratory gas flow tubing, manufacturing particles with a mass median aerodynamic diameter of ~ 4.5 µM and high aerosol concentration. In vitro studies demonstrated biochemical and biophysical integrity of postnebulization surfactant. Lung aerosol deposition was monitored by a laserphotometric technique. In lungs with sham inhalation of saline, tracheal instillation of surfactant (~ 11 mg/kg body weight, infused over 50 min) provoked substantial V A/Q mismatch and limited shunt flow, whereas lung surfactant deposition by ultrasonic nebulization ( ~ 7 to 9 mg/kg body weight; nebulization time, 50 min) did not interfere with physiologic gas exchange. Tween 20 inhalation provoked severe V A/Q mismatch with predominant shunt-flow ( ~ 21%). This was not reversed by "rescue" application of instilled surfactant, but largely reversed by nebulized surfactant (shunt reduced to 5.5%; p < 0.01). Analysis of postaerosol lavage fluid demonstrated partial reconstitution of surface activity by nebulized surfactant. We conclude that ultrasonic nebulization may be employed for efficient delivery of functionally intact natural surfactant to the distal bronchoalveolar space. This approach effects rapid improvement of gas exchange in a model of acute homogeneous lung injury.




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