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Subcutaneous injection of N-nitroso-N-methylurethane (NNNMU) produces an acute lung injury mimicking the adult respiratory distress syndrome. NNNMU-injured rats treated with intratracheal Survanta, 100 mg phospholipid/kg body weight, air, or normal saline were observed for 24 h. Twenty-four hours after treatment survival among Survanta-treated rats was significantly greater than for air- and saline-treated rats (9/15 vs. 2/15 and 3/15, respectively). The alveolar-to-arterial O2 gradient was lower in Survanta-treated than in either air- or saline-treated rats during the 24-h period. Analysis of bronchoalveolar lavage fluid revealed a higher phospholipid: protein ratio (1.73 +/- 0.31 Survanta-treated, 0.20 +/- 0.05 air control, and 0.41 +/- 0.17 saline control) and a more normal phospholipid composition among treated than control rats. Minimum dynamic surface tension was significantly lower among treated rats (10.9 +/- 2.9 dyn/cm) than air and saline control rats (36.0 +/- 0.6 and 35.8 +/- 1.0 dyn/com, respectively). In vitro mixing of surfactant with pulmonary edema proteins significantly raised the minimum surface tension of surfactant from a group of Survanta-treated, NNNMU-injured rats (8.7 +/- 3.5 dyn/cm before and 32.0 +/- 0.5 dyn/cm after mixing). Intratracheal Survanta shows a beneficial effect on physiologic parameters and biochemical and functional characteristics of alveolar surfactant for 24 h in rats with NNNMU-induced acute lung injury.

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