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British Journal of Anaesthesia, 2000, Vol. 84, No. 5 600-607
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Laboratory Investigation

Comparison of exogenous surfactant and positive end-expiratory pressure therapies in a model of human breast milk-induced acute lung injury in rabbits{dagger}

C. Chin1, B. O’Hare1, J. Lerman1 and J. Endo 1

1 Department of Anaesthesia and the Research Institute, The Hospital For Sick Children and University of Toronto, Toronto, Ontario, Canada

J. Lerman, Department of Anaesthesia and the Research Institute, The Hospital For Sick Children and University of Toronto, Toronto, Ontario, Canada

To evaluate surfactant and positive end-expiratory pressure (PEEP) as potential therapies for the acute lung injury after tracheal instillation of 0.8 ml kg–1 human breast milk (HBM) acidified to pH 1.8, adult white rabbits were anaesthetized, tracheostomized, ventilated and randomized to (six rabbits per treatment): (i) no treatment after HBM (control); (ii) exogenous Bovine surfactant (100 mg kg–1) 1 h after HBM; (iii) PEEP-pre (0.5 kPa PEEP) before and after HBM; or (iv) PEEP-post (0.5 kPa PEEP) after HBM. A fifth group of six rabbits received no tracheal instillate (no aspirate). The alveolar to arterial oxygen tension gradient (A–aDO2) and dynamic compliance were measured pre-injury and hourly for 4 h. At post-mortem, the lungs were examined histologically. A–aDO2 in all four HBM-injured groups increased to a maximum at 1 h post-injury; A–aDO2 then returned towards the baseline in the surfactant and PEEP-post groups, but remained increased in the PEEP-pre and control groups. Dynamic compliance decreased in all four HBM-injured groups. A–aDO2 and compliance were unchanged in the no aspirate group. Bronchoalveolar architecture after surfactant therapy was normal. We conclude that surfactant is a more effective therapy for HBM-induced lung injury than either 0.5 kPa PEEP-post or PEEP-pre injury.


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