Pulmonary mechanics in ventilated preterm infants with respiratory distress syndrome after exogenous surfactant administration: A comparison between two surfactant preparations

Abstract

The effects of two surfactant preparations on lung mechanics have been studied on 24 ventilated premature infants with respiratory distress syndrome (RDS): 13 were given artificial surfactant (Exosurf Neonatal, Burroughs-Wellcome) and 11 natural porcine surfactant (Curosurf, Laboratoire Serono France). Measurements of respiratory system compliance (Cdyn, Crs) and resistance (Rrs) were performed immediately before surfactant administration and repeated 6, 18, 24, 48, and 72 hours later. With Exosurf treatment, 6 hours after surfactant administration inhaled O2 concentration (FlO2) could be lowered from (0.72 +/- 0.20, to 0.62 +/- 0.33; P < 0.05), whereas Crs did not change (0.37 mL/cmH2O/kg, +/- 0.14 vs. 0.39 +/- 0.12, NS). After 24 hours and during the following days a significant increase in Crs occurred (24 hours post-Exosurf: 0.51 +/- 0.18, P < 0.05). With Curosurf treatment, the improvement in oxygenation was greater and FlO2 could be lowered much more after 6 hours (from FlO2, 0.78 +/- 0.23 to 0.34 +/- 0.11, P < 0.01). This was associated with an increase in Crs (from 0.39 +/- 0.09 to 0.59 +/- 0.17, P < 0.05). During the following days, Crs was significantly higher in the group treated with Curosurf. Resistance was not altered by the type of surfactant preparation used except after 72 hours, when Rrs increased in the group treated with Exosurf. In conclusion, Curosurf appears to be more effective than Exosurf with regard to immediate pulmonary changes in ventilator treated premature infants with RDS. A rapid increase in Crs after Curosurf treatment indicates that recruitment of new functional areas of the lung is likely to be associated with a stabilization of small airways and alveolar units.

Sequential changes in compliance and resistance after bolus administration or slow infusion of surfactant in preterm infants

“…There was no change in R rs 0.5 h [17,19], 1 h [21], 3 h [22] or at different time points after administration of natural surfactant [18,23]. After synthetic surfactant R rs initially remained constant and then increased [23] or decreased, but not before 48 h [24]. There was only one single study with no more than four infants in which C L and R rs were measured at short intervals beginning immediately after administration of natural surfactant.…”

Surfactant for Pediatric Acute Lung Injury

“…Anzueto et al [136] administered nebulized Exosurf® vs. placebo to 725 adults with ARDS secondary to sepsis and found no improvement in any measure of oxygenation and no effect on morbidity or mortality. However, interpretation of these negative results is confounded because both laboratory and clinical studies have documented that Exosurf® has low activity compared to animal-derived surfactants [51, [113][114][115][116][117][142][143][144][145], and aerosolization has not been shown to be as effective as airway instillation in delivering surfactant. Gregory et al [137] reported small benefits in oxygenation in a controlled trial in adults with ARDS who received four 100 mg/kg doses of Survanta®, but with no overall advantage in survival in the 43 surfactant-treated patients studied.…”

Early Respiratory System Mechanics and the Prediction of Chronic Lung Disease in Ventilated Preterm Neonates Requiring Surfactant Treatment

“…This was reported by Van Lierde et al [12] in premature infants who did not receive exogenous surfactant. In the present population the surfactant deficiency was corrected by porcine surfactant instillation resulting in a rapid increase in Crs as previously described [19]. The increase in Crs 18 h after treatment was not significantly different between groups.…”