Pulmonary Distribution and Efficacy of Exogenous Surfactant in Lung-Lavaged Rabbits Are Influenced by the Instillation Technique

Segerer, Hugo; Gelder, Warry van; Angenent, F. W. M.; Woerkens, L. J. P. M. Van; Curstedt, Tore; Obladen, Michael; Lachmann, Burkhard

doi:10.1203/00006450-199310000-00021

Cited by 115 publications

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“…The distribution of endotracheally administered surfactant in mechanically ventilated animals has been studied by numerous groups (17)(18)(19). The different lung lobes develop in a different sequential pattern with the most advanced developed parts of the lungs being the right and left upper lobes (20,21).…”

Section: Discussionmentioning

confidence: 99%

Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

et al. 2014

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Background: A new technique was proposed to administer surfactant to spontaneous breathing preterm infants by placing a thin catheter through the vocal cords. This technique was not studied with respect to oxygenation, gas exchange, surfactant distribution, and lung mechanics. We tested the technique of less-invasive surfactant administration (LISA) in a spontaneous breathing preterm lamb model. Methods: Preterm lambs (n = 12) of 133-134 d gestational age were randomized to the following three groups: (i) continuous positive airway pressure (CPAP) only, (ii) CPAP + LISA, and (iii) intubation and mechanical ventilation with surfactant administration. Surfactant was labeled with samarium oxide. During the next 180 min, blood gas analyses were performed. Postmortem, lungs were removed and surfactant distribution was assessed, and pressure-volume curves were performed. results: Pao 2 in the LISA-treated lambs was significantly higher than in the lambs that exclusively received CPAP. Moreover, Pao 2 values were similar between the LISA-treated and the intubated lambs. Overall, surfactant deposition was less in the LISA lambs, with significantly less surfactant distributed to the right upper lobe. Lung compliance was better in the intubated lambs compared with the LISA-treated lambs, although this did not reach significance. conclusion: LISA improved oxygenation, similar to conventional surfactant application techniques, despite lower surfactant deposition and lung compliance.i n the past decades, preterm infants have been treated with surfactant bolus replacement therapy for respiratory distress syndrome, which usually requires intubation and mechanical ventilation. Surfactant treatment in ventilated infants leads to a relative reduction in bronchopulmonary dysplasia, pneumothorax, and mortality (1,2). Randomized trials indicated that early surfactant therapy compared to delayed rescue surfactant treatment resulted in better respiratory and neurologic outcomes in preterm infants (3).Early surfactant treatment has therefore been combined with intubation and mechanical ventilation. Intubation of the trachea may lead to laryngeal or tracheal injury and requires premedication, which can delay the time to extubation. In addition, mechanical ventilation can damage the vulnerable preterm lungs. It has been hypothesized that avoidance of mechanical ventilation might lead to less bronchopulmonary dysplasia (4,5), as infants that failed initial continuous positive airway pressure (CPAP) therapy and needed subsequent mechanical ventilation showed higher bronchopulmonary dysplasia rates (6).In order to avoid the negative effects of mechanical ventilation, a new technique was recently introduced to administer surfactant endotracheally to spontaneously breathing preterm infants by placing a small feeding or arterial catheter through the vocal cords (7,8). This technique proved to be feasible in clinical practice with first attempt success rate above 80% (8-10). This technique was referred to as minimally invasive surfactant therap...

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Section: Discussionmentioning

confidence: 99%

Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

et al. 2014

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“…Another commonly used technique involves the admixture of coloured microspheres to exogenous surfactant, and the pattern of distribution has been found to be equal to [ 14 C]-labelled DPPC in rabbit lungs after surfactant depletion [5]. Again, the lungs were cut into 50 [6] to 70 [5] pieces after which the colourant was dissolved from the microspheres and quantified.…”

Section: Discussionmentioning

confidence: 99%

“…Again, the lungs were cut into 50 [6] to 70 [5] pieces after which the colourant was dissolved from the microspheres and quantified. Thus, it is a very demanding technique which requires additional technical equipment, personnel, and a second session for lung processing alone.…”

Section: Discussionmentioning

confidence: 99%

“…Determination of the distribution of radioactively labelled surfactant requires considerable effort such as collaboration with nuclear medicine departments [3,4] and expensive discarding of these radioactively polluted animals. Lung processing for evaluating distribution of exogenous surfactant using the coloured microsphere technique needs additional staff and an extra session to cut the lung into 50±70 pieces before washing out the colorant affixed to the microspheres [5,6].…”

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A new simple method of staining exogenous surfactant in experimental research

Krause¹,

Orlowska-Volk²,

Hendrik³

et al. 2000

Eur Respir J

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Two commonly used techniques in experimental lung research have helped to determine which variables influence surfactant distribution within the lung: radioactive labelling of surfactant components and admixture of coloured microspheres to surfactant. However, neither technique allows the description of surfactant distribution at the alveolar level. The aim of this study was to establish a new technique using histology colourants for admixture to exogenous surfactant to make exogenous surfactant visible by light microscopy.In a step by step approach the authors evaluated the properties of a variety of green colourants when added to a natural porcine surfactant preparation for their ability to homogeneously mix with surfactant, to bind to surfactant, to adhere to a glass slide, to not be "overstained" by standard haematoxylin-eosin and Elastica van Giesson staining, to not influence in vitro surface tension properties of surfactant using a Wilhelmy balance, to not influence oxygenation and ventilation in a lung-lavage rat model and to preserve their colour and adherence to exogenous surfactant on lung specimens visualized by light microscopy.Only one of the tested green histology colourants (Green Dye1) fulfilled all requirements and showed a brilliant green colour in a distribution pattern typical of surfactant at the alveolar level.It is concluded that the authors have established a new, simple and inexpensive method of staining exogenous surfactant for evaluation of its distribution by light microscopy at the alveolar level. Eur Respir J 2000; 15: 949±954.

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“…Surfactant blocks lipopolysaccharide (LPS) signaling and inhibits proinflammatory cytokine secretion in human alveolar macrophages [12,13], and deficiency of surfactant protein increases the inflammatory response to LPS in vitro [14,15]. Several experimental and clinical studies indicated that surfactant proteins attenuate acute lung injury and/or production of inflammatory cytokines in the lungs [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Exogenous surfactant instillation attenuates inflammatory response to acid-induced lung injury in rat

Jian

Koizumi

Tsushima

et al. 2010

Pulmonary Pharmacology & Therapeutics

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The present study was performed to investigate the role of exogenous surfactant on hydrochloric acid (HCL) -induced lung injury in rats. Six-week-old male Sprague-Dawley rats were anesthetized by intraperitoneal injection of pentobarbital sodium (40 mg/kg) and HCL (0.1 N, 2 mL/kg) or normal saline (NS, 2 mL/kg) was instilled into the trachea. Thirty minutes after HCL instillation, surfactant at a dose of 60 mg (=2 mL)/body or NS (2 mL) was instilled into the rat lungs. Animals in another experimental group were also treated with the same dose of surfactant supplement 2 hours after the first administration. Bronchoalveolar lavage fluid (BALF) was obtained 5 hours after HCL instillation. In BALF, increases in total nuclear cell counts, neutrophil counts, optical density at 412 nm as an indicator of pulmonary hemorrhage, neutrophil elastase activity, concentrations of albumin and cytokine-induced neutrophil chemoattractant (CINC) induced by HCL instillation were significantly attenuated by surfactant treatment. The wet-to-dry weight (W/D) ratio in the lung and partial oxygen tension (P O2 ) were also estimated; surfactant treatment significantly attenuated the W/D ratio and improved deteriorated P O2 induced by HCL. Additional surfactant supplementation did not show further beneficial effects on HCL-induced lung injury compared with a single treatment. These results suggest that surfactant shows an anti-inflammatory effect on acid lung injury in rats but the beneficial effects may be dose limited.

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Pulmonary Distribution and Efficacy of Exogenous Surfactant in Lung-Lavaged Rabbits Are Influenced by the Instillation Technique

Cited by 115 publications

References 0 publications

Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

Effects of less-invasive surfactant administration on oxygenation, pulmonary surfactant distribution, and lung compliance in spontaneously breathing preterm lambs

A new simple method of staining exogenous surfactant in experimental research

Exogenous surfactant instillation attenuates inflammatory response to acid-induced lung injury in rat

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