Surfactant administration prior to one lung ventilation: physiological and inflammatory correlates in a piglet model.

ABSTRACT

OBJECTIVES: To test the hypothesis that surfactant, when given prophylactically during one lung ventilation (OLV), improves physiological stability and reduces inflammation. METHODS: Prospective controlled animal study. After 30 min of mechanical ventilation, surfactant was administered to the left lung of the treatment group. Right lung mechanical ventilation continued for 3 hr, after which the left lung was unblocked. Bilateral mechanical ventilation was continued for 30 min thereafter. Physiological parameters and biomarkers of inflammation in plasma, lung tissue homogenates, and bronchoalveolar lavage (BAL) were measured. MEASUREMENTS AND MAIN RESULTS: Oxygenation improved in the surfactant group, reaching statistical significance at 3 hr of OLV and again after 30 min of bilateral mechanical ventilation following the OLV. Plasma levels of interleukin (IL)-1 ß, IL-6, and tumor necrosis factor (TNF)-α showed a trend for reduction. The lung homogenates from the ventilated lungs had significantly lower levels of IL-1 ß (P < 0.01) and IL-6 (P < 0.01). The BAL specimen showed an overall reduction in the cytokine levels; IL-1 ß was significantly lower in the ventilated lungs (P < 0.01). CONCLUSIONS: Surfactant administration improves oxygenation and decreases inflammation, as evidenced by a decrease in several inflammatory cytokines both in the plasma and lungs of a piglet model of OLV.