Research article

Surfactant replacement and open lung concept – Comparison of two treatment strategies in an experimental model of neonatal ARDS

Anne Hilgendorff^1,2 , Ece Aslan¹ , Thomas Schaible³ , Ludwig Gortner⁴ , Thorsten Baehner¹ , Michael Ebsen⁵ , Jochen Kreuder¹ , Clemens Ruppert⁶ , Andreas Guenther⁵ and Irwin Reiss^1,7

¹Dept. of Pediatrics and Neonatology, University of Giessen and Marburg, Germany

²Dept. of Perinatology Grosshadern, Ludwig-Maximilian-University, Munich, Germany

³Dept. of Pediatrics, University Hospital Mannheim, Germany

⁴Dept. of Pediatrics, University Homburg Saar, Germany

⁵Dept. of Pathology, University of Bochum, Germany

⁶Dept. of Internal Medicine, University of Giessen and Marburg, Germany

⁷Dept. of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands

author email corresponding author email

BMC Pulmonary Medicine 2008, 8:10doi:10.1186/1471-2466-8-10

Published:	14 July 2008

Abstract

Background

Several concepts of treatment in neonatal ARDS have been proposed in the last years. The present study compared the effects of open lung concept positive pressure ventilation (PPV_OLC) with a conventional ventilation strategy combined with administration of two different surfactant preparations on lung function and surfactant homoeostasis.

Methods

After repeated whole-lung saline lavage, 16 newborn piglets were assigned to either PPV_OLC (n = 5) or surfactant treatment under conventional PPV using a natural bovine (n = 5) or a monomeric protein B based surfactant (n = 6).

Results

Comprehensive monitoring showed each treatment strategy to improve gas exchange and lung function, although the effect on Pa_O2 and pulmonary compliance declined over the study period in the surfactant groups. The overall improvement of the ventilation efficiency index (VEI) was significantly greater in the PPV_OLC group. Phospholipid and protein analyses of the bronchoalveolar lavage fluid showed significant alterations to surfactant homoeostasis in the PPV_OLC group, whereas IL-10 and SP-C mRNA expression was tendentially increased in the surfactant groups.

Conclusion

The different treatment strategies applied could be shown to improve gas exchange and lung function in neonatal ARDS. To which extent differences in maintenance of lung function and surfactant homeostasis may lead to long-term consequences needs to be studied further.