Abstract

HERRERA, Néstor R. et al. Influence of pulmonary recruitment on exogenous surfactant effects. Medicina (B. Aires) [online]. 2006, vol.66, n.1, pp.17-23. ISSN 0025-7680.

An experimental modelwas devised to study the effects of a sustained insufflation maneuver on the immediate response to exogenous surfactant administration and the effects of baseline pulmonary volume subsequently used in 20 adult albino rats. Lung-injury was induced by repeated lavages with saline solution. Gas exchange, hemodynamic status, lung mechanics and histopathology were assessed. The rats were divided into four experimental groups. Group 1 was delivered 30 cmH₂O sustained insufflation over 15 seconds prior to the surfactant. It was subsequently ventilated at positive end-expiratory pressure (PEEP) of  10 cm H₂O. Group 2 did not receive sustained insufflation and was ventilated at PEEP of 10 cm H₂O. Group 3 was delivered sustained insufflation and was ventilated with PEEP of 4 cm H₂O; and group 4 did not receive sustained insufflation and was ventilated with PEEP of 4 cm H₂O. The surfactant immediate effect was not modified by previous sustained insufflation administration. Increased PaO₂ associated to high functional residual capacity (FRC) (Group 1 p=0.0001; Group 2 p=0.0001), regardless of  sustained insufflation, was observed. The use of sustained insufflation prior to surfactant administration along with high FRC ventilation was associated with polymorphonuclear infiltrates beneath the bronchiolar epithelium (p=0.008). Our results do not advocate the use of sustained insufflation prior to the administration of exogenous surfactant.

Keywords : exogenous surfactant; recruitment maneuvers; ventilation strategies; positive end expiratory pressure levels; sustained insufflation.

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