Abstract
ObjectivesSurfactant (SF) and partial liquid ventilation (PLV) improve gas exchange and lung mechanics in neonatal RDS. However, variations in the effects of SF and PLV with degree of lung immaturity have not been thoroughly explored.SettingExperimental Neonatal Respiratory Physiology Research Unit, Cruces University Hospital.DesignProspective, randomized study using sealed envelopes.Subjects36 preterm lambs were exposed (at 125 or 133-days of gestational age) by laparotomy and intubated. Catheters were placed in the jugular vein and carotid artery.InterventionsAll the lambs were assigned to one of three subgroups given: 20 mL/Kg perfluorocarbon and managed with partial liquid ventilation (PLV), surfactant (Curosurf®, 200 mg/kg) or (3) no pulmonary treatment (Controls) for 3 h.Measurements and Main ResultsCardiovascular parameters, blood gases and pulmonary mechanics were measured. In 125-day gestation lambs, SF treatment partially improved gas exchange and lung mechanics, while PLV produced significant rapid improvements in these parameters. In 133-day lambs, treatments with SF or PLV achieved similarly good responses. Neither surfactant nor PLV significantly affected the cardiovascular parameters.ConclusionSF therapy response was more effective in the older gestational age group whereas the effectiveness of PLV therapy was not gestational age dependent.
Highlights
The introduction of exogenous surfactant (SF) into clinical practice revolutionized the management of neonatal respiratory distress syndrome (RDS), and, more than 30 years later, remains an invaluable tool for the prophylaxis and treatment of neonates with immature lungs.Generally, intratracheal instillation of exogenous SF to preterm babies produces a rapid improvement in gas exchange, decreases the incidence of pneumothorax and reduces mortality
SF therapy response was more effective in the older gestational age group whereas the effectiveness of partial liquid ventilation (PLV) therapy was not gestational age dependent
Perfluorocarbon (PFC) liquid ventilation is an experimental therapy with proven efficacy in the treatment of various pulmonary diseases including meconium aspiration, congenital diaphragmatic hernia and neonatal RDS [3,4,5]
Summary
The introduction of exogenous surfactant (SF) into clinical practice revolutionized the management of neonatal respiratory distress syndrome (RDS), and, more than 30 years later, remains an invaluable tool for the prophylaxis and treatment of neonates with immature lungs.Generally, intratracheal instillation of exogenous SF to preterm babies produces a rapid improvement in gas exchange, decreases the incidence of pneumothorax and reduces mortality. The introduction of exogenous surfactant (SF) into clinical practice revolutionized the management of neonatal respiratory distress syndrome (RDS), and, more than 30 years later, remains an invaluable tool for the prophylaxis and treatment of neonates with immature lungs. The effectiveness of SF is, affected by clinical variables including exogenous antenatal steroids, lung injury and ventilation, and by gestational age (GA) of the immature lung. Perfluorocarbon (PFC) liquid ventilation is an experimental therapy with proven efficacy in the treatment of various pulmonary diseases including meconium aspiration, congenital diaphragmatic hernia and neonatal RDS [3,4,5]. Intrapulmonary PFCs improve compliance by replacing the gas-liquid interface by a liquid-liquid interface and, due to their high density, gravitate to dependent parts of the lung, reopening collapsed alveoli and redistributing pulmonary blood flow to ventilated regions, improving the ventilation-perfusion ratio [7]. Several clinical trials of PLV have been performed in which efficacy results have been more promising in neonatal and pediatric lung injury [8,9,10] than in the adult lung injury [9,11]
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