Abstract
In some infants, administration of surfactant has been associated with an acute decrease in blood pressure. We hypothesized that independent of patent ductus arteriosus, low blood volume sensitizes to a negative hemodynamic response to surfactant supplementation. Respiratory failure was induced by bronchoalveolar lavage (BAL) in 30 young rabbits that were paralyzed and ventilated using tidal volumes of 10 ml/kg. After BAL, 15 ml/kg blood was withdrawn while the same volume of one of the following was infused: Ringer's lactate (n = 12); 5% albumin (n = 5); or leukocyte-free red blood cells (RBC, n = 6). The controls were not phlebotomized (n = 7). After blood withdrawal and transfusion, natural surfactant was given (100 mg/kg). The blood volume and pulmonary capillary leak were calculated. Cardiac output (CO) and vascular resistances were measured (Ringer's lactate; n = 5; controls, n = 4). Blood withdrawal and replacement had no immediate effect on either lung function or hemodynamics. Surfactant supplementation improved the gas exchange in all but the albumin-treated animals that had increased protein concentration in epithelial lining fluid. In the Ringer's lactate group, there was a 35% decrease (p < 0.05) in blood pressure, a 28% decrease (p < 0.05) in CO, and a 54% increase (p < 0.05) in pulmonary vascular resistance, shortly after surfactant administration. In the other groups, there was either a transient (controls) or no (RBC and albumin groups) decrease in blood pressure. The total blood volume and the intrapulmonary blood volume were lower in the Ringer's lactate group than in the RBC group. According to the present results, blood pressure and CO may decrease acutely when exogenous surfactant is administered coincidental with blood loss.
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Bland RD, McMillan DD, Bressack MA, Dong L (1980) Clearance of liquid from lungs of newborn rabbits. J Appl Physiol 49:171–177
Chu J, Clements JA, Cotton EK, Klaus MH, Sweet AY, Tooley WH (1967) Neonatal pulmonary ischemia. Pediatrics 40:709–766
Clyman RI, Mauray F, Heymann MA, Roman C (1982) Cardiovascular effects of patent ductus arteriosus in preterm lambs with respiratory distress. J Pediatr 111:579–587
Couser RJ, Ferrara TB, Ebert J, Hoekstra RE, Fangman JJ (1990) Effects of exogenous surfactant therapy on dynamic compliance during mechanical breathing in preterm infants with hyaline membrane disease. J Pediatr 116:119–124
Covan F, Whitelaw A, Wertheim D, Silverman M (1991) Cerebral blood flow velocity changes after rapid administration of surfactant. Arch Dis Childhood 66:1105–1109
Goerke J (1992) Surfactant and lung mechanics. In: Robertson B, Van Golde LMG, Batenburg (eds) Pulmonary Surfactant: From Molecular Biology to Clinical Practice. Elsevier, Amsterdam, pp 165–192
Hallman M, Merritt TA, Akino T, Bry K (1991) Surfactant protein A, phosphatidylcholine and surfactant inhibitors in epithelial lining fluid: correlation with surface activity, severity of respiratory distress syndrome and outcome of small premature infants. Am Rev Respir Dis 144:1376–1384
Hallman M, Merritt TA, Schneider H, Epstein BL, Mannino F, Edwards DK, Gluck L (1983) Isolation of human surfactant from amniotic fluid and a pilot study of its efficacy in respiratory distress syndrome. Pediatrics 71:473–482
Hamasaki Y, Mojarad M, Saga T, Tai H-H, Said SI (1984) Platelet-activating factor raises airway and vascular pressures and induces edema in lungs perfused with platelet-free solution. Am Rev Respir Dis 129:742–746
Heldt G, Pesonen E, Merritt TA, Elias W, Sahn DJ (1989) Closure of ductus arteriosus and mechanics of breathing in preterm infants after surfactant replacement therapy. Pediatr Res 25:305–310
Hellstrom-Westas L, Bess A, Skov L, Greisen G, Svenningsen N (1992) Cerebroelectrical depression following surfactant treatment in preterm neonates. Pediatrics 89:643–647
Holm BA, Enhoming G, Notter RH (1988) Biophysical mechanism by which plasma proteins inhibit lung surfactant activity. Chem Phys Lipids 49:49–55
Ikegami M, Jacobs H, Jobe A (1983) Surfactant function in respiratory distress syndrome. J Pediatr 102:443–447
Jobe A, Jacobs H, Ikegami M, Jones S (1983) Cardiovascular effects of surfactant suspensions given by tracheal instillation to premature lambs. Pediatr Res 17:444–448
Jobe AH (1993) Pulmonary surfactant therapy. N Engl J Med 328:861–868
Kääpä P, Seppänen M, Kero P, Saraste M (1993) Pulmonary hemodynamics after synthetic surfactant replacement in neonatal respiratory distress syndrome. J Pediatr 123:115–119
Lachmann B, Robertson B, Vogel J (1980) In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Anaethesiol Scand 24:231–236
Merritt TA, Soll RF, Hallman M (1993) Overview of exogenous surfactant replacement therapy. J Intensive Care Med 8:205–228
Moya FR, Hoffman DR, Zhao B, Johnston JM (1993) Platelet-activating factor in surfactant preparations. Lancet 341:858–860
Raj JU (1987) Alveolar liquid pressure measurement by micropuncture in isolated lungs of mature and immature fetal rabbits. J Clin Invest 79:1579–1588
Rudolph AM, Auld PAM, Golinko RJ, Paul MH (1961) Pulmonary vascular adjustments in the neonatal period. Pediatrics 28:28–34
Saugstad OD, Tubman TR, Gloppestad K, Halliday HL, Oyaseater S, Curstedt T, Robertson B (1992) Raised plasma hypoxanthine levels as a prognostic sign in preterm babies with respiratory distress syndrome treated with natural surfactant. J Perinat Med 20:375–385
Segerer H, van Gelder W, Angenent FW, van Woerkens LJ, Curstedt T, Obladen M, Lachmann B (1993) Pulmonary distribution and efficacy of exogenous surfactant in lung-lavaged rabbits are influenced by the instillation technique. Pediatr Res 34:490–494
Shimada S, Kasai T, Konishi M, Fujiwara T (1994) Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant. J Pediatr 125:270–277
Skov L, Bell A, Greisen G (1992) Surfactant administration and the cerebral circulation. Biol Neonate 61:31–36
Sun RY, Nieman GF, Hakim TS, Chang HK (1987) Effects of lung volume and alveolar surface tension on pulmonary vascular resistance. J Appl Physiol 62:1622–1626
Tate RM, Morris HG, Schroeder WR, Repine JR (1984) Oxygen metabolites stimulate thromboxane production and vasoconstriction in isolated saline-perfused rabbit lungs. J Clin Invest 74:608–613
Taylor AE, Parker JC (1985) Pulmonary interstitial spaces and lymphatics. In: Fishman AP, Fisher AB, Geiger SR (eds) Handbook of Physiology. Section 3. The Respiratory System. American Physiological Society, Bethesda, MD, Vol 1 pp 167–230
Ward PA, Warren JS, Johnson KJ (1988) Oxygen radicals, inflammation, and tissue injury. Free Rad Biol Med 5:403–408
Zapol WM, Snider MT (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296:476–480
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arsotti, M.B., Chundu, V., Silvka, S. et al. Hemodynamics of respiratory failure in rabbit model: Effect of surfactant supplementation. Lung 174, 255–268 (1996). https://doi.org/10.1007/BF00173140
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DOI: https://doi.org/10.1007/BF00173140