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Am. J. Respir. Crit. Care Med., Volume 163, Number 5, April 2001, 1135-1142

Evaluation of Exogenous Surfactant in HCl-induced Lung Injury

ANGELA M. BRACKENBURY, PRAMOD S. PULIGANDLA, LYNDA A. McCAIG, VARONA NIKORE, LI-JUAN YAO, RUUD A. W. VELDHUIZEN, and JAMES F. LEWIS

Departments of Physiology and Medicine, Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada

The efficacy of exogenous surfactant administration is influenced by numerous factors, which has resulted in variable outcomes of clinical trials evaluating this treatment for the acute respiratory distress syndrome (ARDS). We investigated several of these factors in an animal model of acid aspiration including different surfactant preparations, and different delivery methods. In addition, high-frequency oscillation (HFO), a mode of mechanical ventilation known to recruit severely damaged lungs, was utilized. Lung injury was induced in adult rabbits via intratracheal instillation of 0.2 N HCl followed by conventional mechanical ventilation (CMV) until PaO2/FIO2 values ranged from 220 to 270 mm Hg. Subsequently, animals were given one of three surfactants administered via three different methods and physiological responses were assessed over a 1-h period. Regardless of the surfactant treatment strategy utilized, oxygenation responses were not sustained. In contrast, HFO resulted in a superior response compared with all surfactant treatment strategies involving CMV. The deterioration in physiological parameters after surfactant treatment was likely due to overwhelming protein inhibition of the surfactant. In conclusion, various surfactant treatment strategies were not effective in this model of lung injury, although the lungs of these animals were recruitable with HFO, as reflected by the acute and sustained oxygenation improvements.




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