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RATIONALE FOR A SECOND DOSE SURFACTANT TREATMENT IN SEVERE RESPIRATORY FAILURE

Newborn infants with respiratory distress who fall to respond to surfactant treatment receive a second dose surfactant. The effect of this strategy on the distribution of surfactant to the lung is unknown. We therefore investigated the distribution of the first (100 mg/kg) and second dose (50 mg/kg body weight) of surfactant (Alvo-fact®) in 6 lung lavaged rabbits. We used Ce and Ru microspheres that were mixed with the surfactant. Arterial PO2 increased from 5.7±0.5 to 10.6±1.2 kPa (mean±SEM) after the first and from 20.1±6.4 to 30.1±6.2 kPA (p<0.05) after the second dose. Thereafter the rabbits were killed and the lungs were cut in 200 pieces (10-50 mg). The radioactivity of Ce and Ru microspheres were measured and distribution histograms were obtained. Histograms of the first, second, and, total dose of surfactant showed similar non-uniform distribution. Correlation coefficients of the Ce and Ru radioactivity in the different lung lobes ranged from 0.03 to 0.28. This indicates that the second dose is directed both to areas that initially received surfactant and to areas that were still surfactant deficient that were aerated by this second dose, resulting in a further rise in PO2. We conclude that a second dose surfactant does not lead to homogenous distribution of surfactant but results in a significant rise in PO2.