The physiologic effects of surfactant treatment on gas exchange in newborn premature infants with hyaline membrane disease

• Published in: Pediatric research Vol. 34; no. 4; pp. 495 - 501
• Main Authors: COTTON, R. B, OLSSON, T, LAW, A. B, PARKER, R. A, LINDSTROM, D. P, SILBERGERG, A. R, SUNDELL, H. W, SANDBERG, K
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-10-1993
• Subjects: Biological and medical sciences; Biological Products; Birth Weight; Drug Combinations; Fatty Alcohols - therapeutic use; Female; Gestational Age; Humans; Hyaline Membrane Disease - physiopathology; Hyaline Membrane Disease - therapy; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Premature; Male; Medical sciences; Oxygen - blood; Pharmacology. Drug treatments; Phosphorylcholine; Polyethylene Glycols - therapeutic use; Pulmonary Surfactants - therapeutic use; Respiratory Function Tests; Respiratory system; Human; Premature; Lung disease; Exogenous; Replacement therapy; Respiratory disease; Treatment efficiency; Exploration; Hyaline membrane; Newborn diseases; Chemotherapy; Lung function; Newborn; Prematurity; Pulmonary surfactant; Respiratory distress; Gas exchange; Biological effect
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1203/00006450-199310000-00022

To describe the physiologic effects of surfactant treatment on gas exchange in human premature infants with hyaline membrane disease, functional residual capacity (FRC), tidal volume (VT), the alveolar portion of tidal volume (VA), alveolar ventilation (VA), nitrogen clearance index, effective breath fraction calculated as VA/VT, compliance of the respiratory system, and arterial oxygen and carbon dioxide tensions were measured in 17 patients before and 0.5, 2, and 6 h after the administration of a single dose of either a synthetic surfactant (SS), Exosurf (n = 10), or a bovine surfactant (BS), Survanta (n = 7). By 2 h, treatment with either BS or SS was followed by an increase in the arterial/alveolar ratio of PO2 (a/A) and in FRC (p < 0.01 for both a/A and FRC). The a/A and FRC improved sooner (p < 0.001) and to a greater extent (p < 0.01) after BS than after SS. Compliance of the respiratory system and VT were decreased after either BS or SS at 0.5 h (p < 0.01) and remained decreased after SS at 2 h (p < 0.01). There was no significant change in VA or VA after either BS or SS. Because FRC and a/A increased without an accompanying increase in VA, VA, or compliance of the respiratory system, we believe that the immediate increase in FRC in this study was caused by stabilization of gas exchange units already being ventilated in addition to recruitment of new units.