Bronchoalveolar lavage versus bolus administration of lucinactant, a synthetic surfactant in meconium aspiration in newborn lambs

Abstract

This study was designed to study effects of lung lavage versus the classical bolus instillation with a peptide-based synthetic surfactant (lucinactant) in a model of Meconium Aspiration Syndrome (MAS). Eighteen newborn lambs received meconium and were randomized to: the experimental meconium installation (eMAS) group-lambs with eMAS kept on conventional mechanical ventilation (control); the SF-Bolus group-eMAS receiving a lucinactant bolus (30 mg/ml); or the D-SF-Lavage group-eMAS treated with dilute lucinactant bronchoalveolar lavage (10 mg/ml). Systemic and pulmonary arterial pressures, blood gases, and pulmonary mechanics were recorded for 180 min. In addition, the intrapulmonary distribution of the lucinactant was determined using dye-labeled microspheres. Following meconium instillation, severe hypoxia, hypercapnia, acidosis, and pulmonary hypertension developed, and dynamic compliance decreased (50% from baseline). After lung lavage with dilute lucinactant, gas exchange significantly improved versus bolus instillation (P < 0.05). Further, only in the lavage group did pulmonary arterial pressure return to basal values and dynamic compliance significantly increased. Both lung lavage and bolus techniques for the administration of lucinactant resulted in a non-uniform lung distribution. In conclusion, in newborn lambs with respiratory failure and pulmonary hypertension induced by meconium, lung lavage with dilute lucinactant seems to be an effective and safe alternative for treatment for MAS.

Surfactant with and without bronchoalveolar lavage in an experimental model of meconium aspiration syndrome

“…Similar findings have been reported by our service using the same experimental model, but lower doses of this surfactant (bolus of 100 mg/kg) [19,20] , and in a recent lamb study using artificial surfactant (lucinactant, Surfaxin ® , 180 mg/kg) [15] . Other animal models and human studies have shown that bolus administration of surfactant is associated with variable and usually modest improvement.…”

Effect of exogenous pulmonary surfactants on mortality rate in neonatal respiratory distress syndrome: A network meta-analysis of randomized controlled trials

“…Consequently, surfactant replacement is gaining popularity as a standard therapy for management for NRDS [36]. Surfaxin (lucinactant) is the classical bolus instillation with a synthetic peptide-based surfactant [37]. Curosurf, also known as poractant alfa, is an exogenous porcine derived lung surfactant that enhances the clearance of apoptotic neutrophils [38].…”

Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome

“…The OI was calculated as mean airway pressure (cm H 2 O) × FiO 2 / PaO 2 (mm Hg) × 100 (34). To assess pulmonary ventilation independent of ventilator settings, ventilatory efficiency index was calculated as 3,800/PIP -positive end-expiratory pressure (cm H 2 O) × respiratory frequency (cycles per min) × PaCO 2 (34).…”