Ultrasonic nebulization for efficient delivery of surfactant in a model of acute lung injury - Impact on gas exchange
Ultrasonic nebulization for efficient delivery of surfactant in a model of acute lung injury - Impact on gas exchange
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DOI：
10.1164/ajrccm.156.2.9609092
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发表时间：
1997-08-01
影响因子：
24.7
通讯作者：
Walmrath, D
中科院分区：
文献类型：
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作者：
Schermuly, R;Schmehl, T;Walmrath, D
我们研究了超声雾化与滴注外源性表面活性剂对灌流兔肺中吸入洗涤剂引起的气体交换异常的影响。采用多重惰性气体消除技术评价通气-灌注（（V）over dot A/（Q）over dot）分布。对于天然牛表面活性剂（Alveofact）的雾化，将超声装置与吸气气流管对齐放置，制造具有类似于4.5 μ M的质量中值空气动力学直径和高气溶胶浓度的颗粒。体外研究证明了雾化后表面活性剂的生物化学和生物物理完整性。肺气溶胶沉积监测激光光度技术。在假吸入生理盐水的肺中，气管滴注表面活性剂（类似于11 mg/kg体重，输注50 min）引起显著（V）过点A/（Q）过点失配和有限的分流流量，而超声雾化肺表面活性剂沉积（类似于7 - 9 mg/kg体重;雾化时间，50 min）不干扰生理气体交换。吐温20吸入引起严重的（V）过点/（Q）过点不匹配，主要是分流（类似于21%）。这不能通过滴注表面活性剂的“抢救"应用逆转，但在很大程度上通过雾化表面活性剂逆转（分流减少至5.5%; p < 0.01）。分析postaerosol灌洗液证明部分重建的表面活性剂雾化。我们的结论是，超声雾化可用于有效地提供功能完整的天然表面活性剂的远端支气管肺泡空间。这种方法在急性均质肺损伤模型中实现了气体交换的快速改善。
We investigated the effect of ultrasonic nebulization versus instillation of exogenous surfactant on gas exchange abnormalities provoked by detergent inhalation in perfused rabbit lungs. Ventilation-perfusion ((V)over dot A/(Q) over dot) distribution was assessed by the multiple inert gas elimination technique. For nebulization of natural bovine surfactant (Alveofact(R)), an ultrasonic device was placed in line with the inspiratory gas flow tubing, manufacturing particles with a mass median aerodynamic diameter of similar to 4.5 mu M and high aerosol concentration. In vitro studies demonstrated biochemical and biophysical integrity of postnebulization surfactant. Lung aerosol deposition was monitored by a laserphotometric technique. In lungs with sham inhalation of saline, tracheal instillation of surfactant (similar to 11 mg/kg body weight, infused over 50 min) provoked substantial (V) over dot A/(Q) over dot mismatch and limited shunt flow, whereas lung surfactant deposition by ultrasonic nebulization (similar to 7 to 9 mg/kg body weight; nebulization time, 50 min) did not interfere with physiologic gas exchange. Tween 20 inhalation provoked severe (V) over dot/(Q) over dot mismatch with predominant shunt-flow (similar to 21%). This was not reversed by ''rescue'' application of instilled surfactant, but largely reversed by nebulized surfactant (shunt reduced to 5.5%; p < 0.01). Analysis of postaerosol lavage fluid demonstrated partial reconstitution of surface activity by nebulized surfactant. We conclude that ultrasonic nebulization may be employed for efficient delivery of functionally intact natural surfactant to the distal bronchoalveolar space. This approach effects rapid improvement of gas exchange in a model of acute homogeneous lung injury.