Am. J. Respir. Crit. Care Med., Volume 156, Number 4, October 1997, 1058-1065

Exogenous Surfactant and Partial Liquid Ventilation
Physiologic and Pathologic Effects

JEANNE D. MROZEK, KENDRA M. SMITH, DENNIS R. BING, PAT A. MEYERS, SUSAN C. SIMONTON, JOHN E. CONNETT, and MARK C. MAMMEL

Infant Pulmonary Research Center, Children's Health Care-St. Paul, St. Paul; and Departments of Pediatrics and Biostatistics, University of Minnesota, Minneapolis, Minnesota

We compared the effects of surfactant and partial liquid ventilation (PLV), and the impact of administration order, on oxygenation, respiratory system compliance (Crs), hemodynamics, and lung pathology in an animal lung injury model. We studied four groups: surfactant alone (S; n = 8); partial liquid ventilation alone (PLV-only; n = 8); surfactant followed by partial liquid ventilation (S-PLV; n = 8); and partial liquid ventilation followed by surfactant (PLV-S; n = 8). Following treatments, all animals had improved oxygenation index (OI) and Crs. Animals in PLV groups showed continued improvement over 2 h (% change OI: PLV-S 83% versus S 47%, p < 0.05; % change Crs: S-PLV 73% versus S 13%, p < 0.05). We also saw administration-order effects: surfactant before PLV improved Crs (0.92 ml/cm H₂O after surfactant versus 1.13 ml/cm H₂O after PLV, p < 0.02) without changing OI, whereas surfactant after PLV did not change Crs and OI increased (5.01 after PLV versus 8.92 after surfactant, p < 0.03). Hemodynamics were not different between groups. Pathologic analysis demonstrated decreased lung injury in dependent lobes of all PLV-treated animals, and in all lobes of S-PLV animals, when compared with the lobes of the S animals (p < 0.05). We conclude that surfactant therapy in combination with PLV improved oxygenation, respiratory system mechanics, and lung pathology to a greater degree than surfactant therapy alone. Administration order affected initial physiologic response and ultimate pathology: surfactant given before PLV produced the greatest improvements in pathologic outcomes.

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