Physiologic response and lung distribution of lavage versus bolus Exosurf in piglets with acute lung injury.

Balaraman, Venkataraman; Sood, Sneha; Finn, Kuuleialoha C.; Hashiro, Glenn M; Uyehara, Catherine F. T.; Easa, David

doi:10.1164/ajrccm.153.6.8665043

Cited by 40 publications

(19 citation statements)

References 18 publications

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“…The advantages of the lavage technique could also help explain the unexpected beneficial effects in the E-LAVAGE group, confirming our previous experience with lavage Exosurf [2,3]. This non-protein-containing surfactant preparation has not been shown to be as effective as protein-containing surfactants such as 2 Survanta and Infasurf [7,15].…”

Section: Discussionsupporting

confidence: 69%

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Lavage Administration of Dilute Surfactant in a Piglet Model of Meconium Aspiration

Meister

Balaraman

Ramirez

et al. 2004

Lung

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Maldistribution of exogenous surfactant may preclude any clinical response in acute lung injury associated with surfactant dysfunction. Our previous studies have shown the effectiveness of surfactant lavage after homogenous lung injury. The present study utilizes a histologically confirmed non-homogeneous lung injury model induced by saline lung-lavage followed by meconium injected into a mainstem bronchus. Piglets were then treated with Infasurf® or Exosurf® by lavage (I-LAVAGE, n = 7; E-LAVAGE, n = 5) or bolus (I-BOLUS, n = 8; E-BOLUS, n = 5), or went untreated (CONTROL, n = 4). Lavage administration utilized a dilute surfactant (35 ml/kg; 4mg phospholipid/ ml) instilled into the lung, followed by gravity drainage. The retained doses of the respective surfactant in the lavage and bolus groups were similar. Results showed that the surfactant distribution was more uniform in the lavage groups compared to the bolus groups. Significant and consistent increases in PaO 2 were observed in the lavage groups compared to the bolus groups and the controls. PaO 2 (mmHg) at 240 min posttreatment: I-LAVAGE = 297 ± 54, E-LAVAGE =280 ± 57; I-BOLUS = 139 ± 31; E-BOLUS = 152 ± 29; C = 119 ± 73 (mean ± SEM). Other improved pulmonary function parameters favored lavage administration. We conclude that better surfactant distribution achieved by lavage administration can be more effective than bolus administration in this type of nonhomogeneous lung injury.

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Section: Discussionsupporting

confidence: 69%

“…In the past 10 years, several investigators [6,11,18,25,27], including our group [2,3] have reported on a new administration technique for surfactant called "lavage administration." Unfortunately, there are significant differences in the administration technique amongst the studies.…”

Section: Introductionmentioning

confidence: 99%

Lavage Administration of Dilute Surfactant in a Piglet Model of Meconium Aspiration

Meister

Balaraman

Ramirez

et al. 2004

Lung

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“…At the same time, instilled surfactant volume impacts intrapulmonary drug distribution, which is already compromised by edema and inflammation as noted earlier. Studies in animal models of ALI/ARDS have indicated that the distribution of exogenous surfactant can be improved by instilling larger fluid volumes or utilizing associated bronchoalveolar lavage [151][152][153][154], but the feasibility and/or utility of these approaches in clinical practice is uncertain. Clinical studies on intratracheal or bronchoscopic instillation of exogenous surfactants in patients with ALI/ARDS have used a range of instilled volumes, with doses as high as 300 mg/kg [155] and as low as 25 mg/kg [26].…”

Section: Delivery Methods and Dosages For Exogenous Surfactant Therapmentioning

confidence: 99%

Surfactant for Pediatric Acute Lung Injury

Willson¹,

Chess²,

Notter³

2008

Pediatric Clinics of North America

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SynopsisThis article reviews exogenous surfactant therapy and its use in mitigating acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) in infants, children, and adults. Biophysical and animal research documenting surfactant dysfunction in ALI/ARDS is described, and the scientific rationale for treatment with exogenous surfactant is discussed. Major emphasis is on reviewing clinical studies of surfactant therapy in pediatric and adult patients with ALI/ARDS. Particular advantages from surfactant therapy in direct pulmonary forms of these syndromes are described. Also discussed are additional factors affecting the efficacy of exogenous surfactants in ALI/ARDS, including the multifaceted pathology of inflammatory lung injury, the effectiveness of surfactant delivery in injured lungs, and composition-based activity differences among clinical exogenous surfactant preparations.

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“…Both of these techniques have been shown to have a diminished ability to deliver surfactant uniformly when lung injury is nonhomogenous, as evident in the early stages of ARDS [18,[24][25][26]. Another novel method of surfactant delivery is by lavage administration [5,6,9,30,35,37]. Coined 'surfactant lavage,' it is characterized by delivering large dilute volumes of surfactant into the lungs followed by immediate drainage.…”

Section: Introductionmentioning

confidence: 99%

“…Coined 'surfactant lavage,' it is characterized by delivering large dilute volumes of surfactant into the lungs followed by immediate drainage. This method has shown promising results in delivering surfactant uniformly, removing alveolar proteins, and improving pulmonary function [5,6,30].…”

Section: Introductionmentioning

confidence: 99%

Surfactant Lavage with Lidocaine Improves Pulmonary Function in Piglets after HCl-Induced Acute Lung Injury

Huang

Uyehara

Balaraman

et al. 2004

Lung

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Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. The pathophysiology of ARDS includes abnormalities of surfactant function as well as pulmonary inflammation. Immunomodulating drugs, like Lidocaine, have shown some success in decreasing inflammation in ARDS. We attempted to combine surfactant lavage's ability to reverse the surfactant dysfunction, while acting as a vehicle to deliver Lidocaine. Gravity-driven surfactant (Infasurf) lavage (35 ml/kg) was administered alone or mixed with Lidocaine after severe HCl acid injury (0.3N; 3cc/kg) in neonatal piglets. Treatment groups included: control (C) (n = 5), surfactant lavage (SL) (35 ml/kg-diluted Infasurf) (n = 7) and SL mixed with Lidocaine (SL+L) (n = 7). About 26-27% of the lavage was retained (phospholipid 73-74 mg/kg; Lidocaine 1.8 mg/kg). Oxygenation progressively increased in the SL and SL+L groups over the 4-hour period (at 240 min: C = 99 ± 14; SL = 154 ± 39; SL+L = 230 ± 40 mmHg) (p < 0.05). PaCO 2 increased in all groups from 43± 0.3to 55 ± 0.7 mmHg. Only SL+L showed a reduction in PaCO 2 (at 240 min: C = 54 ± 4; SL = 53 ± 7; SL +L = 49 ± 2 mmHg) (p < 0.05). Finally, SL and SL + L had superior characteristics during the quasistatic pressure volume (PV) procedure as compared to Control (p < 0.05). In our HCl ALI model, SL improved oxygenation and quasi-static lung compliance over C. The pulmonary function effects of SL were further enhanced by the addition of Lidocaine to the surfactant suspension. Combining therapeutic agents with surfactant lavage may be an effective strategy in ALI.

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Physiologic response and lung distribution of lavage versus bolus Exosurf in piglets with acute lung injury.

Cited by 40 publications

References 18 publications

Lavage Administration of Dilute Surfactant in a Piglet Model of Meconium Aspiration

Lavage Administration of Dilute Surfactant in a Piglet Model of Meconium Aspiration

Surfactant for Pediatric Acute Lung Injury

Surfactant Lavage with Lidocaine Improves Pulmonary Function in Piglets after HCl-Induced Acute Lung Injury

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