Effects of surfactant distribution and ventilation strategies on efficacy of exogenous surfactant

The effectsof both surfactant distribution patterns and ventilation strategiesutilized after surfactant administration were assessed in lung-injuredadult rabbits. Animals received 50 mg/kg surfactant via intratrachealinstillation in volumes of either 4 or 2 ml/kg. A subset ofanimals from each treatment group was euthanized for evaluation of theexogenous surfactant distribution. The remaining animals wererandomized into one of three ventilatory groups: group1 tidal volume(VT) of 10 ml/kg with 5 cmH₂O positive end-expiratorypressure (PEEP)]; group 2 (VT of 5 ml/kg with 5 cmH₂O PEEP); orgroup 3 (VT of 5 ml/kg with 9 cmH₂O PEEP). Animals wereventilated and monitored for 3 h. Distribution of the surfactant wasmore uniform when it was delivered in the 4 ml/kg volume. When thedistribution of surfactant was less uniform, arterial PO₂ values were greater ingroups 2 and3 compared with group1. Oxygenation differences among the differentventilation strategies were less marked in animals with the moreuniform distribution pattern of surfactant (4 ml/kg). In bothsurfactant treatment groups, a high mortality was observed with theventilation strategy used for group 3.We conclude that the distribution of exogenous surfactant affects theresponse to different ventilatory strategies in this model of acutelung injury.