Meniscus formation during tracheal instillation of surfactant

The method ofsurfactant instillation into the lungs for treatment of neonatalrespiratory distress syndrome is an important attribute of delivery,and it may determine the overall efficacy of treatment. Previousstudies primarily focused on the rate at which the bolus is instilled.These findings show that rapid injections lead to a more homogenousdistribution, whereas slow infusions drain into the dependent lung withrespect to gravity, resulting in a heterogeneous deposition. Theseresults suggest that it is beneficial to form a meniscus, from which amore homogenous dispersal can proceed. The objective of the presentstudy was to develop a functional criterion for meniscus formationduring bolus injection. An in vitro experiment was used to examine theclinical setting of surfactant instillation. The physical variablesexamined were the bolus viscosity (µ) and density (), gravity(g), injection rate (Q), orientation of thetrachea with respect to gravity (), tracheal size(D), surface tension (), andcatheter size (d). All quantitieswere varied, except gravity and catheter size. Experimental resultsshow that a meniscus will form whenN_St > 0.004Re^2/3, whereN_St is Stokesnumber and Re is Reynolds number,N_St = µQ/D⁴gsin,a ratio of viscous effects to gravitational effects, and Re = QD/d²µ,a ratio of inertial effects to viscous effects. Rapid injections, highviscosity, and small inclination with respect to gravity promotemeniscus formation. These results can be used to refine the guidelinesfor administration of surfactant replacement therapy.