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Surfactant deactivation in a pediatric model induces hypovolemia and fluid shift to the extravascular lung compartment
Author(s) -
Díaz Franco,
Erranz Benjamín,
Donoso Alejandro,
Carvajal Cristóbal,
Salomón Tatiana,
Torres María,
Cruces Pablo
Publication year - 2013
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12037
Subject(s) - medicine , hypovolemia , pulmonary surfactant , pulmonary edema , pulmonary compliance , hypoxemia , hypervolemia , anesthesia , lung , respiratory distress , bronchoalveolar lavage , ards , cardiology , blood volume , chemistry , biochemistry
Summary Background Surfactant deficiency is the pivotal abnormality in Neonatal and Acute Respiratory Distress Syndrome. Surfactant deactivation can produce hypoxemia, loss of lung compliance, and pulmonary edema, but its circulatory consequences are less understood. Objective To describe the sequential hemodynamic changes and pulmonary edema formation after surfactant deactivation in piglets. Methods Surfactant deactivation was induced by tracheal instillation of polysorbate 20 in 15 anesthetized and mechanically ventilated Large White piglets. The hemodynamic consequences of surfactant deactivation were assessed at 30, 120, and 240 min by transpulmonary thermodilution and traditional methods. Results Surfactant deactivation caused hypoxemia, reduced lung compliance, and progressively increased lung water content ( P < 0.01). Early hypovolemia was observed, with reductions of the global end‐diastolic volume and stroke volume ( P < 0.05). Reduced cardiac output was observed at the end of the study ( P < 0.05). Standard monitoring was unable to detect these early preload alterations. Surprisingly, the bronchoalveolar protein content was greatly increased at the end of the study compared with baseline levels ( P < 0.01). This finding was inconsistent with the notion that the pulmonary edema induced by surfactant deactivation was exclusively caused by high surface tension. Conclusions Hypovolemia develops early after surfactant deactivation, in part due to the resulting fluid shift from the intravascular compartment to the lungs.