Regular Article| Volume 95, ISSUE 7, P612-617, July 2001

A comparison of surfactant delivery with conventional mechanical ventilation and partial liquid ventilation in meconium aspiration injury

      This paper is only available as a PDF. To read, Please Download here.


      The objective of this study was to compare surfactant (SF) distribution and physiological effects after standard SF delivery during conventional mechanical ventilation (CMV) with that using partial liquid ventilation (PLV). A model of meconium aspiration syndrome (MAS) was developed using two groups of adult rats (n=14). After meconium instillation of 2·5 ml kg−1(20% v/w), SF/CMV: (n=7) CMV and SF/PLV: (n=7) PLV, received14C-labeled surfactant (4 ml kg−1) delivered intratracheally in four aliquots over 20 min in both groups. Sequential measurements of arterial blood chemistry and lung mechanics were performed in all animals. At the conclusion of experiments, lungs were inflated (30 cmH2O), dried, sectioned and evaluated for radioactivity in disintegrations per minute (DPM). Surfactant distribution was improved (P<0·01) with PLV as compared to CMV with 48·8% of the pieces vs. 30·9% of the pieces receiving within 25% of the mean amount of surfactant, respectively. Further, regional distribution was also significantly more uniform with PLV than CMV: left vs right (P<0·01) lung and ventral vs. dorsal (P<0·01) regions. Finally, arterial PO2and ventilation efficiency index were significantly (P<0·01) greater post-treatment in SF/PLV than SF/CMV. These data demonstrate surfactant delivery with PLV, as compared to CMV alone, to be an improved method of delivering surfactant in MAS and suggest the possible utility of SF/PLV combination therapy for its treatment of other etiologies of neonatal respiratory distress.




        • Wiswell TE
        • Tuggle JM
        • Turner BS
        Meconium aspiration syndrome: have we made a difference?.
        Pediatrics. 1990; 85: 715
        • Tran N
        • Lowe C
        • Sivieri EM
        Sequential effects of acute meconium obstruction on pulmonary function.
        Pediatr Res. 1980; 14: 34-38
        • Gooding CA
        • Gregory GA
        Roentgenographic analysis of meconium aspiration of the newborn.
        Radiology. 1971; 100: 131
        • Rossi EM
        • Philipson EH
        • Williams TG
        Meconium aspiration syndrome: intrapartum and neonatal attributes.
        Am J Obstet Gynecol. 1989; 161: 1106-1110
        • Patterson K
        • Kapur SP
        • Chandra RS
        Persistent pulmonary hypertension of the newborn: pulmonary pathologic aspects.
        Persp Ped Pathol. 1988; 12: 139-154
        • Spitzer AR
        • Davis J
        • Bernbaum J
        Pulmonary hypertension and persistent fetal circulation in the newborn.
        Clinics Perinatol. 1988; 15: 389-413
        • Wu JM
        • Yeh TF
        • Wang JY
        The role of pulmonary inflammation in the development of pulmonary hypertension in newborn with meconium aspiration syndrome (MAS).
        Pediatr Pulmonol. 1999; 18: 205-208
        • Soukka H
        • Rautanen M
        • Halkola L
        Meconium aspiration induces ARDS-like pulmonary response in lungs of ten-week-old pigs.
        Pediatr Pulmonol. 1997; 23: 205-211
        • Cleary GM
        • Antunes MJ
        • Ciesielka DA
        Exudative lung injury is associated with decreased levels of surfactant proteins in a rat model of meconium aspiration.
        Pediatrics. 1997; 100: 998-1003
        • Tyler DC
        • Murphy J
        • Cheney FW
        Mechanical and chemical damage to lung tissue caused by meconium aspiration.
        Pediatrics. 1978; 62: 454
        • Davey AM
        • Becker JD
        • Davis JM
        Meconium aspiration syndrome: physiological and inflammatory changes in a newborn piglet model.
        Pediatr Pulmonol. 1993; 16: 101-108
        • Sun B
        • Curstedt T
        • Robertson B
        Surfactant inhibition in experimental meconium aspiration.
        Acta Paediatrica. 1993; 82: 182-189
        • Moses D
        • Holm BA
        • Spitaale P
        Inhibition of pulmonary surfactant function by meconium.
        Am J Obstet Gynecol. 1991; 164: 477-481
        • Paranka MS
        • Walsh WF
        • Stancombe BB
        Surfactant lavage in a piglet model of meconium aspiration syndrome.
        Pediatr Res. 1992; 31: 625-628
        • Chen CT
        • Toung T JK
        • Rogers MC
        Effect of intra-alveolar meconium on pulmonary surface tension properties.
        Crit Care Med. 1985; 13: 233
        • Clark DA
        • Nieman GF
        • Thompson JE
        Surfactant displacement by meconium free fatty acids: an alternative explanation for atelectasis in meconium aspiration syndrome.
        J Pediatr. 1987; 110: 765-770
        • Sun B
        • Curstedt T
        • Song G
        Surfactant improves lung fuction and morphology in newborn rabbits with meconium aspiration.
        Biol Neonate. 1993; 63: 96-104
        • Al-Mateen KB
        • Dailey K
        • Grimes MM
        Improved oxygenation with exogenous surfactant administration in experimental meconium aspiration syndrome.
        Pediatr Pulmonol. 1994; 17: 75-80
        • Walther F
        • Taeusch W
        • Findlay R
        Surfactant replacement therapy for meconium aspiration syndrome.
        Pediatrics. 1996; 97: 48-52
        • Aten RL
        • Notter RH
        • Kendig JW
        Surfactant treatment of full-term newborns with respiratory failure.
        Pediatrics. 1991; 87: 101-107
        • Greenspan J.S.
        • Wolfson MR
        • Rubenstein SD
        Liquid ventilation of human preterm neonates.
        J Pediatr. 1990; 117: 106-111
        • Leach CL
        • Greenspan JS
        • Rubenstein SD
        Partial liquid ventilation with perflubron: A pilot safety and efficacy study in premature newborns with severe RDS who have failed conventional therapy and exogenous surfactant.
        N Eng J Med. 1996; 335: 761-767
        • Foust R
        • Tran N
        • Cox C
        Liquid assisted ventilation: An alternative ventilatory strategy for acute meconium aspiration injury.
        Pediatr Pulmonol. 1996; 21: 316-322
        • Shaffer TH
        • Douglas PR
        • Lowe
        Liquid ventilation: improved gas exchange and lung compliance in preterm lambs.
        Pediatr Res. 1983; 17: 179-188
        • Shaffer TH
        • Lowe CA
        • Bhutani VK
        Liquid ventilation: effects on pulmonary function in meconium-stained lambs.
        Pediatr Res. 1984; 19: 49-53
        • Furhman BP
        • Paczan PR
        • DeFrancisis M
        Perfluorocarbon associated gas exchange.
        Crit Care Med. 1991; 19: 712-722
        • Wolfson MR
        • Greenspan JS
        • Shaffer TH
        Pulmonary adminisration of vasoactive substances by perfluorochemical liquid ventilation in neonatal lambs.
        Pediatrics. 1996; 97: 449-455
        • Wolfson MR
        • Shaffer TH
        Pulmonary administration of drugs (PAD): a new approach for drug delivery using liquid ventilation.
        FASEB J. 1990; 4: A1105
        • Zelinka MA
        • Wolfson MR
        • Calligaro I
        A comparison of intratracheal and intravenous administration of gentamicin during liquid ventilation.
        Eur J Pediatr. 1997; 156: 401-404
        • Lisby DA
        • Ballard PL
        • Fox WW
        Enhanced distribution of adenovirus-mediated gene transfer to lung parenchyma by perfluorochemical liquid.
        Hum Gene Ther. 1997; 8: 919-928
        • Fox WW
        • Weis CM
        • Cox CA
        Pulmonary administration of gentamicin during liquid ventilation in a newborn lamb lung injury model.
        Pediatrics. 1997; 100: 1-5
        • Lowe Leach C
        • Holm B
        • Morin FC
        Partial liquid ventilation in premature lambs with respiratory distress syndrome: Efficacy and compatibility with exogenous surfactant.
        J Pediatr. 1995; 126: 412-420
        • Mrozek JD
        • Smith KM
        • Simonton SC
        Perfluorocarbon priming and surfactant: Physiologic and pathologic effects.
        Crit Care Med. 1999; 27: 1916-1922
        • Mrozek JD
        • Smith KM
        • Bing DR
        Exogenous surfactant and partial liquid ventilation: Physiologic and pathologic effects.
        Am J Respir Crit Care Med. 1997; 156: 1058-1065
        • Gilliard N
        • Richman R
        • Merritt T
        Effect of volume and dose on the pulmonary distribution of exogenous surfactant administered to normal rabbits or to rabbits with oleic acid injury.
        Am Rev Respir Dis. 1990; 141: 743-747
        • Enhorning G
        • Grossman G
        • Robertson B
        Tracheal deposition of surfactant before the first breath.
        Am Rev Respir Dis. 1973; 107: 921-927
        • Takashi U
        • Ikegami M
        • Rider ED
        Distribution of surfactant and ventilation in surfactant-treated lambs.
        J Appl Physiol. 1994; 76: 45-55
        • Van Der Bleek J
        • Plotz FB
        • Van Overbeek FM
        Distribution of exogenous surfactant in rabbits with severe respiratory failure: the effect of volume.
        Pediatr Res. 1993; 34: 154-158
        • Shaffer TH
        • Foust R
        • Wolfson MR
        Analysis of perfluorochemical elimination from the respiratory system.
        J Appl Physiol. 1997; 83: 1033-1040
        • Wolfson MR
        • Kechner NE
        • Roache RF
        Perfluorochemical rescue of natural surfactant treated preterm lambs: Effect of perflubron dose and ventilatory frequency during gas ventilation.
        J Appl Physiol. 1998; 84: 624-640