Abstract
Clinical trials testing exogenous surfactant administration for the treatment of the Acute Respiratory Distress Syndrome (ARDS) have given variable results. Two factors contributing to the variable responses of this treatment are the specific exogenous surfactant preparation used and the method by which the surfactant is delivered to the injured lung. The current study investigated the potential of a new exogenous surfactant, recombinant SP-C based surfactant (rSP-C, Byk Gulden, Germany), to improve oxygenation in a large animal model of ARDS. The surfactant was delivered to the injured lungs by either tracheal instillation, bronchoscopic instillation or aerosolization. Lung injury was induced in adult sheep by repetitive saline lavage and subsequent mechanical ventilation for 1 hour. Two separate experiments were performed. In the first experiment, animals were then randomized into three different surfactant-instillation groups; 1) tracheal instillation of 100mgJkg; 2) tracheal installation of 25 mgJkg; 3) bronchoscopic installation of 25 mgJkg. The second experiment was performed to evaluate the efficacy of rSP-C surfactant when delivered as an aerosol. The aerosol rSP-C surfactant was delivered using a small catheter placed at the distal end of the endotracheal tube (Trudell Medical, London Ont) and was timed to deliver surfactant during inspiration only. This group of animals was compared to animals receiving air through a similar catheter. In both experiments the r-SP-C product was labeled with [14C]- dipalmitoyl phosphatidylcholine to assess the recovery and lobar distribution patterns of the exogenous surfactant. Blood gases were monitored at 30 min intervals for four hours after instillation or after the start of aerosolization. After the four hour monitoring period, animals were euthanized by an overdose of pentobarbitol and the lung were processed to examine the recovery and lobar distribution patterns of the exogenous material.
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