Intensive Care Medicine

, Volume 28, Issue 8, pp 1131–1137

Exogenous surfactant reduces ventilator-induced decompartmentalization of tumor necrosis factor α in absence of positive end-expiratory pressure

  • Jack J. Haitsma
  • Stefan Uhlig
  • Ulrike Lachmann
  • Serge J. Verbrugge
  • Davey L. Poelma
  • Burkhard Lachmann
Experimental

DOI: 10.1007/s00134-002-1377-4

Cite this article as:
Haitsma, J.J., Uhlig, S., Lachmann, U. et al. Intensive Care Med (2002) 28: 1131. doi:10.1007/s00134-002-1377-4

Abstract

Abstract

Objective. To determine the effect of pretreatment with exogenous surfactant on ventilator-induced decompartmentalization of TNF-α.

Design and setting. Prospective, randomized, animal study in the experimental laboratory of a university.

Subjects and interventions. Male Sprague-Dawley rats (n=102) received lipopolysaccharide either intratracheally or intraperitoneally to stimulate TNF-α production; one-half of the animals were pretreated with surfactant. Animals were ventilated for 20 min with a peak inspiratory pressure/positive end-expiratory pressure (PEEP) ratio of either 45/0 or 45/10 (frequency 30 bpm, I/E ratio 1:2, FIO2=1).

Measurements and results. Blood gas tension and arterial pressures were recorded 1, 10, and 20 min after the start of mechanical ventilation. After the animals were killed pressure-volume curves were recorded, and bronchoalveolar lavage was performed for assessment of protein content and the small/large surfactant aggregate ratio. TNF-α was determined in serum and bronchoalveolar lavage. Pretreatment with surfactant decreased decompartmentalization of TNF-α during 45/0 ventilation. Addition of a PEEP level of 10 cm H2O reduced decompartmentalization even further. In addition, surfactant prevented deterioration in oxygenation and decreased accumulation of protein in the bronchoalveolar lavage in the zero-PEEP group.

Conclusions. An excess of active surfactant decreases transfer of cytokines across the alveolar-capillary membrane similar to PEEP. The combination of PEEP and surfactant reduces decompartmentalization of TNF-α even further.

Compartmentalization Exogenous surfactant Lung injury Cytokines Positive end-expiratory pressure Multiple-organ failure

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Jack J. Haitsma
    • 1
  • Stefan Uhlig
    • 2
  • Ulrike Lachmann
    • 1
  • Serge J. Verbrugge
    • 1
  • Davey L. Poelma
    • 1
  • Burkhard Lachmann
    • 1
  1. 1.Department of Anesthesiology, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The NetherlandsThe Netherlands
  2. 2.Division of Pulmonary Pharmacology, Research Center Borstel, Borstel, GermanyThe Netherlands