Exogenous surfactant improves lung compliance and oxygenation in adult rats with meconium aspiration

We studied the effects of exogenous surfactant on lung function and morphology in an adult rat model of severe meconium aspiration syndrome. Animals ventilated with 100% oxygen received 4-6 ml of human meconium (25 mg/ml) intratracheally. After 30 min, lung-thorax compliance had decreased by > 30% and arterial PO2 was < 10 kPa. Animals were then treated with no material (MECO group), 0.9% NaCl (MECO-saline group), natural porcine surfactant (NPS group) at a dose of 100 mg/kg, or modified porcine surfactant at a dose of either 100 (MPS100 group) or 200 mg/kg (MPS200 group) and were ventilated for another 180 min. Immediate and sustained improvement of arterial PO2 and compliance was observed in the MPS200 group, whereas the MPS100 and NPS groups showed less pronounced effects. There was a significant improvement of quasi-static lung volumes at maximum insufflation pressure and during deflation in the MPS200, MPS100, and NPS groups. Recordings with Wilhelmy balance showed that minimum surface tension of bronchoalveolar lavage fluid from animals receiving either type or dose of surfactant was significantly lower than in the MECO and MECO-saline groups. Meconium aspiration induced diffuse and prominent atelectasis, intra-alveolar edema, and hyaline membranes. These morphological abnormalities were reversed by exogenous surfactant, especially by the high-dose regimen.

[Animal experiments on meridian-reaching actions of traditional Chinese medicinal herbs]

With the level variations of cAMP and cGMP in cat tissues as the criteria, the meridian actions reaching of Fructus Schisandrae, Radix Stephaniae Tetrandrae and Herba Houttuyniae were studied tentatively in animal experiments. The result obtained in this way approximates to the understanding of the meridian reaching actions of Chinese medicinal herbs as approved by traditional Chinese medicine.

[Heel reconstruction by the composite island flap of the lower leg]

From 1987, 6 to 1992, 6 cases of heel defect were repaired successfully by reverse transfer of the composite island flap from the lateral lower leg. The flap, pedicled with peroneal vessels, consisted of skin, subcutaneous tissue, fibula and adjacent muscles. The contour and function were satisfactory.

[A 5-year retrospective investigation of occupation-related burns in Zhenjiang area]

During the 5 years from June 1986 to June 1991, 221 patients were admitted to our department of burn surgery because of occupation-related burns. The average age was 31.2 years, and 83.4 per cent was male. Most of the patients (79.6 per cent) were referred to our hospital within 24 h of their injury. The most common etiology was flame (33.0 per cent). The mean body surface area of all 221 cases was 17.1 per cent, with a mean full-thickness component of 8.1 per cent.

COMPLICATIONS

inhalation injury 18 cases (8.1 per cent); sepsis 5 cases (2.3 per cent) confirmed by positive blood cultures at an average time of 10.2 days postburn, and the commonest organism was pseudomonas aeruginosa; pneumonia 5 cases (2.3 per cent). The mortality of these 221 cases was 1.8 per cent. The average time of stay in our hospital was 34.3 days. The total expenditure was about 740,000 Yuan. First aid on the spot and early correct treatment are stressed. It is essential to put prevention first, and the measures to lower the incidence of occupation-related burns were discussed to serve as a reference for labor protection department and occupation-related burns institute.

[A clinic report of 54 cases of reconstruction for the anterior segment of eye]

54 cases (54 eyes) of severe injury in the anterior segment of eye with little light perception were treated by reconstruction for the anterior segment of eye. The results showed that the eyeballs in 48 cases (88.9%) were survived successfully, and 28 cases (51.9%) of the grafts were clear. The procedures included keratoplasty, iridectomy, lensectomy, anterior vitrectomy, and reconstruction of the anterior chamber to restore the cosmetic shape of the eyeball. The indications, complications of the operation, and the surgical technique are discussed.

[Comparative studies of 111In-labeled monoclonal antibody using spacer-containing and non-spacer bifunctional chelates: (I). Conjugation, labeling, immunoreactivity and in vitro stability]

Bifunctional chelates containing chemical spacer, succinimido-EGS-DTPA (EGS-DTPA, diester spacer) and 1-[4-(10-maleimidopropyl)amidobenzyl]ethylenediamine-N,N,N', N'- tetraacetic acid (C10-Bz-EDTA, hydrocarbon spacer) were synthesized and compared in vitro with non-spacer chelates, cyclic DTPA dianhydride (cDTPAA) and isothiocyanatobenzyl-EDTA (SCN-Bz-EDTA). The optimum condition for conjugation with chelates, labeling efficiency, immunoreactivity and stability in the serum were investigated with respect to four chelates. The labeling efficiency for EGS-DTPA-A7 and DTPA-A7 was 90% and over 95%, respectively, when reacted by the chelate to antibody ratios of 10:1 for EGS-DTPA and 2:1 for cDTPAA. The labeling efficiency for SCN-Bz-EDTA and C10-Bz-EDTA was 70% and 80%, respectively, when both of the chelates were conjugated with the antibody in a 1:1 ratio. EGS-DTPA-A7 and DTPA-A7 were unstable when incubated in the human serum at 37 degrees C and showed the transchelation to the transferrin fraction of the 111In activity. Furthermore, the radioactivity from 111In-EGS-DTPA-A7 was also found to be associated with the In-DTPA fraction, indicating that the diester spacer was cleaved in the serum. SCN-Bz-EDTA-A7 and C10-Bz-EDTA-A7 were very stable: there was no evidence of transchelation or any activity was dissociated from the conjugated antibody when incubated in the human serum for 168 hrs. Using C10-Bz-EDTA, immunoconjugate with sufficient specific activity was obtained and high immunoreactivity was maintained. It was considerable that the C10-Bz-EDTA immunoconjugate would produce preferable biodistribution than EGS-DTPA immunoconjugate do.

[Comparative studies of 111In-labeled monoclonal antibody using spacer-containing and non-spacer bifunctional chelates: (II). Biodistribution, metabolism and excretion in vivo]

Indium-111-labeled A7 monoclonal antibodies using two spacer-containing chelates, succinimido-EGS-DTPA (EGS-DTPA: diester spacer) and maleimido-C10-Bz-EDTA (C10-Bz-EDTA: hydrocarbon spacer) were investigated in human LS180 colon tumor bearing nude mice and were compared with two non-spacer chelates, cyclic DTPA dianhydride (cDTPAA) and isothiocyanatobenzyl-EDTA (SCN-Bz-EDTA). Compared with immunoconjugates using non-spacer chelates, immunoconjugates using spacer-containing chelates, especially C10-Bz-EDTA-A7 showed lower 111In activity in normal organs. The radioactivity in the liver for C10-Bz-EDTA-A7 decreased continuously till 96 hrs postinjection, however, this liver radioactivity for EGS-DTPA-A7 showed little change after 24 hrs. Moreover, in liver subcellular distribution study, EGS-DTPA-A7 showed a higher activity retention in mitochondrial fraction which contained lysosome, a place for metabolizing and storing of 111In labeled antibody, than that of C10-Bz-EDTA-A7. The C10-Bz-EDTA-A7 conjugate demonstrated more preferable tumor-to-non tumor contrast on the scintigrams than that found with other three immunoconjugates. Up to 96 hrs postinjection, tumor bearing nude mice injecting with immunoconjugates using spacer-containing chelates excreted twice radioactivity from whole body than that excreted by using non-spacer chelates. Interestingly, different from other three chelates, C10-Bz-EDTA-A7 were mainly excreted via feces. We conclude that the decrease of radioactivity in normal tissues in the case of EGS-DTPA-A7 was duo to the rapid decrease of activity in the blood, while in the case of C10-Bz-EDTA-A7 it was due to the quickly excreted small metabolite through faces. 111In labeled C10-Bz-EDTA conjugate is superior, at least when conjugated with A7, to other three chelate conjugates used in this study.

In vitro expression of calcitonin gene-related peptide in human endothelial cells transfected with plasmid and retroviral vectors

Introduction of cDNA encoding human alpha-calcitonin gene-related peptide (CGRP), a potent vasodilator, into cultured human umbilical vein endothelial cells (HUVEC) was undertaken by using plasmids and retroviral vectors. In order to improve expression, modification of context coding sequence for the initiation of CGRP translation and deletion of nontranslated regions of CGRP cDNA in the transfection vectors were tested. Stable transfer of neo in the HUVEC was achieved with both plasmid and retroviral vectors. Integration rates obtained by using retrovirus (approximately 1%), where higher than those achieved with plasmid-mediated transfection (< 1/1000). CGRP expressed in the transfected HUVEC was secreted into culture medium when a leading sequence was included in the expression vectors. CGRP was detected by enzyme-linked immunosorbent assay (ELISA) in the supernatants of both transiently transfected and stably transfected/infected HUVEC. Higher levels of expression were achieved by using plasmid (giving a maximum CGRP concentration of 6.5 +/- 0.5 pM in the supernatant) than retroviruses. Lipofectin-mediated transfer of CGRP cDNA also resulted in transient expression of CGRP in the HUVEC.

Biochemical analysis of proteins recognized by anti-HRP antibodies in Drosophila melanogaster: identification and characterization of neuron specific and male specific glycoproteins

Antibodies recognizing horse radish peroxidase (HRP) stain neurons in Drosophila and other insects. We have used Western blots to analyze and characterize some of the anti-HRP reactive components from Drosophila melanogaster. Anti-HRP reactive components can be reproducibly detected during all developmental stages, although the pattern changes at different developmental times. In adults, there are at least 10 reproducibly stained components. Two of the bands, with molecular sizes of 42 and 80 kDa are likely to be the major contributors to neuronal anti-HRP staining in Drosophila. These components are enriched in adult fly heads. In contrast, many of the other anti-HRP reactive components in adults are enriched in abdomen and are present exclusively or at much higher levels in male flies. We have purified and characterized two of the male specific components with molecular sizes of 62 and 48 kDa. Partial N-terminal amino acid sequencing revealed that the 62 kDa protein is identical to a part of D. melanogaster carboxylesterase to EC 3.1.1.1) while he 48 kDa protein does not match any known sequences. Esterase-6 has previously been shown to be enriched in male accessory gland and consistent with this we show staining of this structure with anti-HRP antibodies.

Effect of endotoxin on lipid order and motion in erythrocyte membranes

Electron paramagnetic resonance employing a lipid-specific spin label has been used to investigate the molecular effects of endotoxin on the physical state of bilayer lipids in rat erythrocyte membranes. When added at a concentration as low as 40 micrograms/ml to whole blood (plasma plus leukocytes present), decreased membrane lipid motion was found in subsequently washed and spin-labeled intact erythrocytes (P < 0.02). However, if endotoxin were added to washed, plasma plus leukocyte-free intact erythrocytes, no change in the motion of the spin label was found, suggesting that plasma-soluble substances and/or leukocytes are required to produce the change in the physical state of lipids. The decreased lipid motion found in these studies is discussed with reference to the known decreased deformability of endotoxin-treated red cells and to the pathogenesis of sepsis.

Ethamsylate and lung permeability in ventilated immature newborn rabbits

The leakage of proteins in the immature neonatal lung can reduce the effect of exogenous surfactant. The effect of ethamsylate, a more specific prostaglandin inhibitor than indomethacin and aspirin-like drugs, on alveolar albumin leak was studied in a group of 27 immature newborn rabbits (gestational age 27 days). A pilot study was carried out using 4 animals and low-dose ethamsylate (10 mg/kg). A second group of animals (n = 12) received at birth, by intravenous injection, ethamsylate (50 mg/kg) and 10% human albumin (7 ml/kg). Animals not receiving ethamsylate (n = 11) served as control group. After 30 min of artificial ventilation with standard tidal volume (10 ml/kg) the lungs were lavaged and the amount of human albumin in lung lavage fluid was determined by immunodiffusion. No statistically significant differences were found in lung-thorax compliance and vascular to alveolar albumin leak between ethamsylate-treated animals and controls (p > 0.5). However, there was a statistically significant negative correlation between protein leak and lung compliance (r = -0.41; p < 0.04). These results suggest no direct influence of early ethamsylate administration on neonatal lung permeability in the immature neonate confirming that lung permeability is inversely related to compliance.

Changes of pulmonary glucocorticoid receptor and phospholipase A2 in sheep with acute lung injury after high dose endotoxin infusion

In a sheep model of acute lung injury induced by an Escherichia coli endotoxin (5 micrograms/kg) with chronic lung lymph fistula (n = 15), we measured the changes in glucocorticoid receptor (GCR) binding capacity in lung tissue by means of radioligand binding assay. The content of cortisol and the activity of phospholipase A2 (PLA2) were also measured. The results showed that the maximal binding capacity (Bmax) of GCR in lung cytoplasma decreased continuously 2 h (113 +/- 3 versus 66 +/- 2 fmol/mg protein, p < 0.01), 4 h (105 +/- 6 versus 52 +/- 3 fmol/mg protein, p < 0.01), and 6 h (105 +/- 5 versus 37 +/- 2 fmol/mg protein, p < 0.01) after endotoxin infusion. Its affinity decreased markedly (p < 0.05) at 6 h after the infusion. The contents of cortisol in plasma elevated at 0.5 h and remained at a high level until 4 h after the infusion. PLA2 activity rose from 97 +/- 25 to 188 +/- 12 U (p < 0.05), 99 +/- 13 to 285 +/- 25 U (p < 0.01), and 106 +/- 14 to 354 +/- 32 U (p < 0.01) at 2, 4, and 6 h after endotoxin infusion, respectively. There was a negative correlation between the Bmax of GCR and PLA2 activity (r = -0.87, p < 0.01). The findings indicate that there was a secondary GCR abnormality and a higher PLA2 activity during endotoxin-induced lung injury. The glucocorticoid hypofunction caused by reduced GCR binding capacity may accelerate the pathologic response of acute lung injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunochemical analysis of the gp120 surface glycoprotein of human immunodeficiency virus type 1: probing the structure of the C4 and V4 domains and the interaction of the C4 domain with the V3 loop

We have probed the structure of the C4 and V3 domains of human immunodeficiency virus type 1 gp120 by immunochemical techniques. Monoclonal antibodies (MAbs) recognizing an exposed gp120 sequence, (E/K)VGKAMYAPP, in C4 were differentially sensitive to denaturation of gp120, implying a conformational component to some of the epitopes. The MAbs recognizing conformation-sensitive C4 structures failed to bind to a gp120 mutant with an alteration in the sequence of the V3 loop, and their binding to gp120 was inhibited by both V3 and C4 MAbs. This implies an interaction between the V3 and C4 regions of gp120, which is supported by the observation that the binding of some MAbs to the V3 loop was often enhanced by amino acid changes in an around the C4 region.

Effects of acute hypoxia on intracranial dynamics in unanesthetized goats

The effects of acute hypoxia on intracranial dynamics were studied in six unanesthetized goats that were subjected to hypobaric hypoxia at a simulated 4,000-m high altitude for 2 h. Another six nonhypoxic goats served as control group for cerebral water content (CWC). In this study, we measured cerebral blood flow (CBF) by electromagnetic flowmeter, intracranial pressure (ICP) through an intraventricular catheter, and CWC by a wet-to-dry weight technique for a given volume of brain tissue. Intracranial compliance was calculated from a pressure-volume index derived from the change in intraventricular pressure after a subarachnoid injection of saline. During acute hypoxia CBF increased from 146.0 +/- 10.60 to 185.3 +/- 7.83 ml x min-1.100 g-1, ICP increased from 15.4 +/- 1.82 to 27.4 +/- 3.84 cmH2O, and CWC increased from 78.7 +/- 0.30 to 79.5 +/- 0.16%, but intracranial compliance decreased from 0.65 +/- 0.28 to 0.36 +/- 0.19 ml/cmH2O. The data suggest that acute hypoxia results in a significant disturbance of intracranial dynamics, which may be one of the important pathophysiological mechanisms of high-altitude cerebral edema and acute mountain sickness.

An analysis of antigenic polypeptides of dengue viruses and their specificity with western blotting

Dengue virus (DV) samples which harvested after having been either propagated in C6/36 cells or passaged by murine intracerebral inoculation were investigated by Western blotting. Two different denaturing methods with the same solution were selected before electrophoresis, one at 60 degrees C for 20 min; the other at 100 degrees C for 5 min. After the samples were heated at 60 degrees C for 20 min, 3 bands of sizes 46 ku, 70 ku and 98 ku were positively recognized by rabbit immunized sera. The peptide of 98 ku was DV group specific; While that of 46 ku could also react with the sera against both heterologous DV serotype and Japanese B encephalitis virus (JEV). After the samples were heated at 100 degrees C for 5 min, 3 peptides in size of 20 ku, 46 ku and 57 ku were recognized by the rabbit sera against both homologous and heterologous DV serotypes, while the peptide of 57 ku could also be recognized by anti-JEV serum. There was no significant difference in the results of Western blot between the DV antigens harvested from cellular culture and those from intra-cerebral inoculation.

Single dose versus two doses of betamethasone for lung maturation in preterm rabbits

Most previous studies of induced lung maturation have used fetal exposures to multiple doses of hormones, and such treatments are associated with fetal growth retardation in rodents and rabbits. This study was designed to evaluate whether single-dose maternal corticosteroid treatments could induce lung maturation without causing fetal growth retardation. Lung maturation was evaluated in 27-d gestational age rabbits by measurements of lung function after preterm delivery and ventilation. Lung function was assessed by measurements of ventilatory requirements, responses to exogenous surfactant, measurements of the recovery of intravascular albumin in the lungs, and surfactant pool sizes. As demonstrated previously, 0.1 mg/kg betamethasone (1 mg = 2.13 mumol betamethasone) given 48 and 24 h before delivery caused both growth retardation (birth weight 20% lower than controls, p < 0.01) and lung maturation (improved compliance, decreased radiolabeled albumin recoveries) despite lower alveolar saturated phosphatidylcholine pool sizes (p < 0.05 versus controls). A single dose of 0.2 mg/kg betamethasone given 48 h before delivery had an equivalent effect on birth weight as the divided doses of 0.1 mg/kg betamethasone, with the only lung maturational effect being a decrease in recovery of labeled albumin in alveolar washes (p < 0.01). A single dose of 0.1 mg/kg betamethasone given 48 h before delivery decreased birth weight by 9.4% (p < 0.01 versus control) but had no effect on any of the lung maturation indicators. Fetal lung maturation caused by maternal corticosteroid is associated with global fetal growth retardation, and a single low dose of corticosteroid can cause growth retardation without inducing lung maturation.(ABSTRACT TRUNCATED AT 250 WORDS)

Surfactant inhibition in experimental meconium aspiration

Human meconium components were separated into a water-methanol soluble phase containing mainly proteins and bilirubin and a chloroform soluble phase containing free fatty acids, triglycerides and cholesterol. Various amounts of original meconium, the water-methanol soluble fraction or the chloroform soluble fraction were added to standard suspensions of porcine surfactant (Curosurf). In a pulsating-bubble or Wilhelmy-balance system, meconium and its subfractions inhibited surfactant activity, but the chloroform soluble fraction had the highest specific inhibitory activity. Original meconium in saline (130 or 65 mg/ml) was instilled into the airways of ventilated near-term newborn rabbits (dose 6 ml/kg). Lung-thorax compliance was reduced by 38% in animals aspirating the higher dose and by 27% in the low-dose group. Histological sections showed intra-alveolar accumulation of fine meconium particles in experimental animals, but no plugging of larger airways. We conclude that respiratory failure from meconium aspiration may be mediated, in part, by inactivation of surfactant.

Normocalcemic blood or crystalloid cardioplegia provides better neonatal myocardial protection than does low-calcium cardioplegia

Although standard blood cardioplegia provides good myocardial protection for cardiac operations in adults, protection of the cyanotic, immature myocardium remains suboptimal. Calcium, which has been implicated in reperfusion injury and in the development of "stone heart" in mature myocardium, is routinely lowered in standard cardioplegic solutions. Immature, neonatal myocardium has lower intracellular calcium stores and is more reliant on extracellular calcium for contraction. To determine if normocalcemic cardioplegia would result in improved cardiac function in the neonatal heart, we conducted a series of experiments using an isolated, blood-perfused working heart model. Thirty-two neonatal piglet hearts (24 to 48 hours) were excised without intervening ischemia and were placed directly on a blood-perfused circuit. Baseline stroke work index was assessed. Hearts were then arrested with cold cardioplegic solution delivered at 45 mm Hg for 2 minutes: group I, low-calcium blood cardioplegic solution (Ca = 0.6 mmol/L); group II, normal-calcium blood cardioplegic solution (Ca = 1.1 mmol/L); group III, University of Wisconsin solution; and group IV, University of Wisconsin solution with added calcium (Ca = 1.0 mmol/L). Cardioplegic solution was administered every 20 minutes for 2 hours and topical hypothermia was used. Hearts were then reperfused with warm whole blood. Functional recovery, expressed as a percentage of control stroke work index, was determined minutes after reperfusion. Hearts preserved with normocalcemic cardioplegic solution (groups II and IV) had complete functional recovery at 60 minutes, whereas hearts preserved with low-calcium cardioplegic solution (groups I and III) achieved functional recoveries of only 80% and 65%, respectively, at a left atrial pressure of 9 mm Hg. Electron micrographs taken 1 hour after reperfusion showed minimal edema and only mild myofibrillar changes. They were identical in both the low-calcium and normocalcemic groups. Complete functional recovery is possible in immature myocardium when calcium is added to either blood or an intracellular crystalloid cardioplegic solution. The addition of calcium does not result in ultrastructural damage and does result in good functional recovery.

Quantitative autoradiography reveals higher densities of specific calcitonin-gene-related peptide receptors in small intramyocardial compared with large epicardial coronary arteries

1. Binding sites for calcitonin-gene-related peptide were localized and characterized in porcine coronary arteries using quantitative autoradiography, and the density of binding sites was compared between large epicardial and small intramyocardial coronary arteries. 2. A single class of binding sites for calcitonin-gene-related peptide with a dissociation constant of 2.1 +/- 0.2 nmol/l was detected in both the large and small coronary arteries. The density of specific binding sites was higher (maximum binding site density 231 +/- 14 fmol/mg of protein) in the small coronary arteries than in the large epicardial coronary arteries (maximum binding site density 108 +/- 5 fmol/mg of protein). beta-Human calcitonin-gene-related peptide showed higher affinity than alpha-human calcitonin-gene-related peptide for the binding sites. Most of the specific binding sites for both peptides in the large coronary artery were localized in the intima and media. 3. In coronary artery from patients with coronary heart disease, there were more binding sites for calcitonin-gene-related peptide in the smooth muscle layer of atheromatous segments (7.2 +/- 0.7 amol/mm2) than in that of normal segments (3.0 +/- 0.3 amol/mm2, P < 0.002). 4. The present findings lend further support to the theory of regional variation in the vasodilator response to calcitonin-gene-related peptide in porcine coronary arteries, which seems to be due to different densities of a single type of receptor for calcitonin-gene-related peptide.

Surfactant improves lung function and morphology in newborn rabbits with meconium aspiration

Nearly mature newborn rabbits (gestational age 29.5 days) were tracheotomized at birth and received, via the tracheal cannula, 6 ml/kg body weight of a filtered saline suspension of human meconium, 65 or 130 mg/ml. Animals were kept in body plethysmographs and ventilated for 60 min with standardized tidal volume (8-10 ml/kg). Aspiration of meconium caused, in both groups, a statistically significant reduction in lung-thorax compliance, elevated PCO2 in heart blood and reduced alveolar volume density (VV) in histological sections. Both groups responded to treatment with exogenous surfactant (Curosurf, 200 mg/kg) with a moderate, statistically significant improvement in lung-thorax compliance, PCO2 and alveolar VV. Our data indicate that respiratory failure after neonatal meconium aspiration may be influenced favorably by treatment with exogenous surfactant.

[Allergen-stimulated release of prostaglandin E, F2 alpha by alveolar macrophages from patients with allergic asthma]

Bronchoalveolar lavage (BAL) was performed in healthy subjects (n = 12) and patients with bronchial asthma (n = 11). Between the two groups there was no significant difference in the total number of cells and the percentage of alveolar macrophages (AM), lymphocytes (L), neutrophils (N) and eosinophils (E) in BAL fluids. When AM were cultured in vitro and stimulated with dermatophagoides farinae (DPF) antigen, the amount of PGE released by AM was significantly increased in the asthmatics. When the asthmatics, AM were sensitized with specific IgE positive serum and stimulated with DPF, they released more PGE and PGF2 alpha than those when specific IgE negative serum was used (P < 0.01). The PGE/PGF2 alpha ratio was significantly decreased. There was positive correlation between the decreased value of PGE/PGF2 alpha and patients, MCH-PC20. The increase in the amount of PGE and PGF2 alpha released and the decrease of PGE/PGF2 alpha ratio might play an important role in the pathogenesis of allergic asthma.

Different ventilation strategies alter surfactant responses in preterm rabbits

The effect of ventilation strategy on in vivo function of different surfactants was evaluated in preterm rabbits delivered at 27 days gestational age and ventilated with either 0 cmH2O positive end-expiratory pressure (PEEP) at tidal volumes of 10-11 ml/kg or 3 cmH2O PEEP at tidal volumes of 7-8 ml/kg after treatment with one of four different surfactants: sheep surfactant, the lipids of sheep surfactant stripped of protein (LH-20 lipid), Exosurf, and Survanta. The use of 3 cmH2O PEEP decreased pneumothoraces in all groups except for the sheep surfactant group where pneumothoraces increased (P < 0.01). Ventilatory pressures (peak pressures - PEEP) decreased more with the 3 cmH2O PEEP, low-tidal-volume ventilation strategy for Exosurf-, Survanta-, and sheep surfactant-treated rabbits (P < 0.05), whereas ventilation efficiency indexes (VEI) improved only for Survanta- and sheep surfactant-treated rabbits with 3 cmH2O PEEP (P < 0.01). Pressure-volume curves for sheep surfactant-treated rabbits were better than for all other treated groups (P < 0.01), although Exosurf and Survanta increased lung volumes above those in control rabbits (P < 0.05). The recovery of intravascular radiolabeled albumin in the lungs and alveolar washes was used as an indicator of pulmonary edema. Only Survanta and sheep surfactant decreased protein leaks in the absence of PEEP, whereas all treatments decreased labeled albumin recoveries when 3 cmH2O PEEP was used (P < 0.05). These experiments demonstrate that ventilation style will alter a number of measurements of surfactant function, and the effects differ for different surfactants.