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

Abstract

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.

Ex Vivo Reconditioning of Marginal Donor Lungs Injured by Acid Aspiration

“…26,27,29,31 Although the lavage method is preferred in most studies, there are differences in terms of the volume of lavage (5 to 35 ml/kg), active vs passive instillation and fluid recovery, and number of lavages performed. 5,6,17,28,30,[32][33][34] Despite these differences, all studies reported improved lung function after dilute surfactant administration.…”

“…The ex vivo lung perfusion method has been proposed originally to assess the function of the lung from a non-heart-beating donor as an interim evaluation of the graft prior to transplantation. 17,18 Recently, Steen et al successfully reconditioned a rejected donor lung due to bilateral pulmonary contusion using an ex vivo perfusion system. 19 We showed that graft function improved with dilute surfactant lavage after high-volume aspiration.…”

Effects of prone and supine position on oxygenation and inflammatory mediator in a hydrochloric acid-induced lung dysfunction in rats

“…A variety of ventilatory maneuvers are employed to combat it, such as mechanical ventilation with prone and/or supine position, positive end expiratory pressure (PEEP), alveolar recruitment, high-frequency ventilation and non-ventilatory maneuvers such as the administration of nitric oxide and surfactant, fluids management, corticoids [6][7][8] .…”

Effect of prone position without PEEP on oxygenation and complacency in an experimental model of lung injury

“…Para o seu combate, utilizam-se várias manobras ventilatórias, como a ventilação mecânica com pressão expiratória positiva final (PEEP), recrutamento alveolar, ventilação de alta freqüência [3][4][5] e manobras não-ventilatórias, como a administração de óxido nítrico, surfactante, balanço hídrico, uso de corticóides [5][6][7][8] , etc.…”