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Reducing Atelectasis Attenuates Bacterial Growth and Translocation in Experimental Pneumonia

Department of Anesthesiology and Laboratory of Pediatrics, Erasmus-MC Faculty, Rotterdam; Department of Neonatology, Emma Children's Hospital AMC; Department of Pathology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and Department of Pediatrics, University of Göttingen, Göttingen, Germany

Correspondence and requests for reprints should be addressed to Anton H. van Kaam, M.D., Department of Neonatology (Room H3-150), Emma Children's Hospital AMC, University of Amsterdam, P.O. Box 22700, 1100 DD, Amsterdam, The Netherlands. E-mail: a.h.vankaam{at}amc.uva.nl

Besides being one of the mechanisms responsible for ventilator-induced lung injury, atelectasis also seems to aggravate the course of experimental pneumonia. In this study, we examined the effect of reducing the degree of atelectasis by natural modified surfactant and/or open lung ventilation on bacterial growth and translocation in a piglet model of Group B streptococcal pneumonia. After creating surfactant deficiency by whole lung lavage, intratracheal instillation of bacteria induced severe pneumonia with bacterial translocation into the blood stream, resulting in a mortality rate of almost 80%. Treatment with 300 mg/kg of exogenous surfactant before instillation of streptococci attenuated both bacterial growth and translocation and prevented clinical deterioration. This goal was also achieved by reversing atelectasis in lavaged animals via open lung ventilation. Combining both exogenous surfactant and open lung ventilation prevented bacterial translocation completely, comparable to Group B streptococci instillation into healthy animals. We conclude that exogenous surfactant and open lung ventilation attenuate bacterial growth and translocation in experimental pneumonia and that this attenuation is at least in part mediated by a reduction in atelectasis. These findings suggest that minimizing alveolar collapse by exogenous surfactant and open lung ventilation may reduce the risk of pneumonia and subsequent sepsis in ventilated patients.

Key Words: open lung ventilation • surfactant • sepsis

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