Abstract
Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. The pathophysiology of ARDS includes abnormalities of surfactant function as well as pulmonary inflammation. Immunomodulating drugs, like Lidocaine, have shown some success in decreasing inflammation in ARDS. We attempted to combine surfactant lavage’s ability to reverse the surfactant dysfunction, while acting as a vehicle to deliver Lidocaine. Gravity-driven surfactant (Infasurf) lavage (35 ml/kg) was administered alone or mixed with Lidocaine after severe HCl acid injury (0.3 N; 3 cc/kg) in neonatal piglets. Treatment groups included: control (C) (n = 5), surfactant lavage (SL) (35 ml/kg-diluted Infasurf) (n = 7) and SL mixed with Lidocaine (SL+L) (n = 7). About 26–27% of the lavage was retained (phospholipid 73–74 mg/kg; Lidocaine 1.8 mg/kg). Oxygenation progressively increased in the SL and SL+L groups over the 4-hour period (at 240 min: C = 99 ± 14; SL = 154 ± 39; SL+L = 230 ± 40 mmHg) (p < 0.05). PaCO2 increased in all groups from 43 ± 0.3 to 55 ± 0.7 mmHg. Only SL+L showed a reduction in PaCO2 (at 240 min: C = 54 ± 4; SL = 53 ± 7; SL+L = 49 ± 2 mmHg) (p < 0.05). Finally, SL and SL + L had superior characteristics during the quasi-static pressure volume (PV) procedure as compared to Control (p < 0.05). In our HCl ALI model, SL improved oxygenation and quasi-static lung compliance over C. The pulmonary function effects of SL were further enhanced by the addition of Lidocaine to the surfactant suspension. Combining therapeutic agents with surfactant lavage may be an effective strategy in ALI.
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References
TE Albertson GP Marelich (1998) ArticleTitlePharmacologic adjuncts to mechanical ventilation in acute respiratory distress syndrome. Crit Care Clin 14 581–610 Occurrence Handle1:CAS:528:DyaK1cXntVGqsrk%3D Occurrence Handle9891629
B Ames (1966) ArticleTitleAssay of inorganic phosphate, total phosphate and phosphatases. Methods Enzymol 8 115–118 Occurrence Handle1:CAS:528:DyaF1cXhvFeksQ%3D%3D
A Anzueto RP Baughman KK Guntupalli (1996) ArticleTitleAerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. N Engl J Med 334 1417–1421 Occurrence Handle1:STN:280:BymB3Mfot1A%3D Occurrence Handle8618579
DG Ashbaugh DB Bigelow TL Petty et al. (1967) ArticleTitleAcute respiratory distress in adults. Lancet 2 319–323 Occurrence Handle1:STN:280:By%2BA28bpsVQ%3D Occurrence Handle4143721
V Balaraman SL Sood KC Finn et al. (1996) ArticleTitlePhysiologic response and lung distribution of lavage versus bolus Exosurf in piglets with acute lung injury. Am J Respir Crit Care Med 153 1838–1843 Occurrence Handle1:STN:280:BymB2sbnslQ%3D Occurrence Handle8665043
V Balaraman J Meister TL Ku et al. (1998) ArticleTitleLavage administration of dilute surfactants after acute lung injury in neonatal piglets. Am J Respir Crit Care Med 158 12–17 Occurrence Handle1:STN:280:DyaK1czisFaktw%3D%3D Occurrence Handle9655700
GR Bernard A Artigas KL Brigham et al. (1994) ArticleTitleThe American-European Consensus Conference on ARDS: definitions, mechanisms, revelant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149 818–824 Occurrence Handle1:STN:280:ByuC28zksVY%3D Occurrence Handle7509706
LJ Bynum AK Pierce (1976) ArticleTitlePulmonary aspiration of gastric contents. Am Rev Respir Dis 114 1129–1136 Occurrence Handle1:STN:280:CSiD1crotlQ%3D Occurrence Handle1008348
CG Cochrane SD Revak A Merritt et al. (1998) ArticleTitleBronchoalveolar lavage with KL4-Surfactant in models of meconium aspiration syndrome. Pediatr Res 44 705–715 Occurrence Handle1:CAS:528:DyaK1cXnt1KisLg%3D Occurrence Handle9803452
BD Conner GR Bernard (2000) ArticleTitleAcute respiratory distress syndrome: potential pharmacologic interventions. Clin Chest Med 21 563–586 Occurrence Handle1:STN:280:DC%2BD3cvmsFeltA%3D%3D Occurrence Handle11019728
RL Doyle N Szaflarski GW Modin et al. (1995) ArticleTitleIdentification of patients with acute lung injury. Am J Respir Crit Care Med 152 1818–1824 Occurrence Handle1:STN:280:BymD1Mvit1A%3D Occurrence Handle8520742
EP Eijking D Gommers KL So et al. (1993) ArticleTitleSurfactant treatment of respiratory failure induced by hydrochloric acid aspiration in rats. Anesthesiology 78 1145–1151 Occurrence Handle1:CAS:528:DyaK3sXks1akurc%3D Occurrence Handle8512108
G Enhorning (1977) ArticleTitlePulsating bubble technique for evaluating pulmonary surfactant. J Appl Physiol 43 198–203
DA Evans RW Wilmott JA Whitsett (1996) ArticleTitleSurfactant replacement therapy for adult respiratory distress syndrome in children. Pediatric Pulm 21 328–336 Occurrence Handle10.1002/(SICI)1099-0496(199605)21:5<328::AID-PPUL9>3.3.CO;2-2 Occurrence Handle1:STN:280:BymA2cvjtVc%3D
AJ Fein JP Weiner-Kronish M Niederman et al. (1986) ArticleTitlePathophysiology of the Adult Respiratory Distress Syndrome: What have we learned from human studies? Crit Care Clin 2 429–453 Occurrence Handle1:STN:280:BieA3M%2FkvFw%3D Occurrence Handle3331557
HG Folkesson MA Matthay CA Hebert et al. (1995) ArticleTitleAcid aspiration-induced lung injury in rabbit is mediated by interleukin-8-dependent mechanisms. J Clin Invest 96 107–116 Occurrence Handle1:CAS:528:DyaK2MXmslyru74%3D Occurrence Handle7615779
MW Hollmann ME Durieux (2000) ArticleTitleLocal anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 93 858–875 Occurrence Handle10.1097/00000542-200009000-00038 Occurrence Handle1:CAS:528:DC%2BD3cXntVyqsrY%3D Occurrence Handle10969322
BA Holm S Matalon (1989) ArticleTitleRole of pulmonary surfactant in the development and treatment of adult respiratory distress syndrome. Anesth Analg 69 805–818 Occurrence Handle1:STN:280:By%2BD2s3mvVM%3D Occurrence Handle2686493
Y Kiyonari K Nishina K Mikawa et al. (2000) ArticleTitleLidocaine attenuates acute lung injury induced by a combination of phospholipase A2 and trypsin. Crit Care Med 28 484–489 Occurrence Handle10.1097/00003246-200002000-00033 Occurrence Handle1:STN:280:DC%2BD3c7ntVClsw%3D%3D Occurrence Handle10708188
T Kobayashi M Ganzuka J Tanigushi et al. (1990) ArticleTitleLung lavage and surfactant replacement for hydrochloric acid aspiration in rabbits. Acta Anaesthesiol Scand 34 216–221 Occurrence Handle1:CAS:528:DyaK3cXls1Ghsbk%3D Occurrence Handle2111628
WJE Lamm RK Albert (1990) ArticleTitleSurfactant replacement improves lung recoil in rabbit lungs after acid aspiration. Am Rev Respir Dis 142 1279–1283 Occurrence Handle1:STN:280:By6D28bgtFI%3D Occurrence Handle2252244
JF Lewis M Ikegami R Higuchi et al. (1991) ArticleTitleNebulized versus instilled exogenous surfactant in an adult injury model. J Appl Physiol 71 1270–1276 Occurrence Handle1:CAS:528:DyaK38XltFw%3D Occurrence Handle1757348
JF Lewis B Tabor M Ikegami et al. (1992) ArticleTitleLung function and surfactant distribution in saline lavaged sheep given instilled versus nebulized surfactant. J Appl Physiol 1256–1264
JF Lewis M Ikegami AH Jobe et al. (1993) ArticleTitlePhysiologic responses and distribution of aerosolized surfactant (Survanta) in a nonuniform pattern of lung injury. Am Rev Respir Dis 147 1364–1370 Occurrence Handle1:STN:280:ByyB2snpvF0%3D Occurrence Handle8503547
JF Lewis AH Jobe (1993) ArticleTitleSurfactant and the adult respiratory distress syndrome. Am Rev Respir Dis 147 218–233 Occurrence Handle1:STN:280:ByyC38fmsFM%3D Occurrence Handle8420422
JF Lewis L McCaig (1993) ArticleTitleAerosolized versus instilled exogenous surfactant in an nonuniform pattern of lung injury. Am Rev Respir Dis 148 1187–1193 Occurrence Handle1:STN:280:ByuD2MjmvVw%3D Occurrence Handle8239152
RR MacGregor RE Thorner DM Wright (1980) ArticleTitleLidocaine inhibits granulocyte adherence and prevents granulocyte delivery to inflamatory sites. Blood 56 203–209 Occurrence Handle1:CAS:528:DyaL3cXlt1Gltrw%3D Occurrence Handle7397378
M Matthay G Rosen (1996) ArticleTitleAcid respiration-induced lung injury: new insight and therapeutic options. Am J Respir Crit Care Med 154 277–278 Occurrence Handle1:STN:280:BymA38fhtFc%3D Occurrence Handle8756794
G Meduri S Headley G Kohler et al. (1995) ArticleTitlePersistent elevation of inflammatory cytokines predicts a poor outcome in ARDS. Chest 107 1062–1073 Occurrence Handle1:STN:280:ByqB38%2Fgs1E%3D Occurrence Handle7705118
JC Meister V Balaraman T Ku et al. (2000) ArticleTitleLavage administration of dilute recombinant surfactant in acute lung injury in piglets. Pediatr Res 47 240–245 Occurrence Handle1:CAS:528:DC%2BD3cXhtFSgtrg%3D Occurrence Handle10674353
K Mikawa N Maekawa K Nishina et al. (1994) ArticleTitleEffect of Lidocaine pretreatment on endotoxin-induced lung injury in rabbits. Anesthesiology 81 689–699 Occurrence Handle1:STN:280:ByuA2sbksFU%3D Occurrence Handle8092515
T Nagase E Ohga E Sudo et al. (1996) ArticleTitleIntercellular adhesion molecule-1 mediates acid aspiration-induced lung injury. Am J Respir Crit Care Med 154 504–510 Occurrence Handle1:STN:280:BymA38fhsVw%3D Occurrence Handle8756829
K Nishina K Mikawa Y Takao et al. (1998) ArticleTitleIntravenous Lidocaine attenuates acute lung injury induced by hydrochloric acid aspiration in rabbits. Anesthesiology 88 IssueID5 1300–1309 Occurrence Handle10.1097/00000542-199805000-00022 Occurrence Handle1:CAS:528:DyaK1cXjsVaqsLs%3D Occurrence Handle9605691
RH Notter M Apostolakos BA Hohn et al. (2000) ArticleTitleSurfactant therapy and its potential use with other agents in terms of infants, children, and adults with acute lung injury. Perspect Neonatol 1 4–20
Y Ohama Y Ogawa (1999) ArticleTitleTreatment of meconium aspiration syndrome with surfactant lavage in an experimental rabbit model. Pediatr Pulmonol 28 18–23 Occurrence Handle10.1002/(SICI)1099-0496(199907)28:1<18::AID-PPUL4>3.0.CO;2-O Occurrence Handle1:STN:280:DyaK1MzjsVGntQ%3D%3D Occurrence Handle10406046
A Ohsaka K Saionji N Sato et al. (1994) ArticleTitleLocal anesthetic lidocaine inhibits the effect of granulocyte colony-stimulating factor on human neutrophil functions. Exp Hematol 22 460–466 Occurrence Handle1:CAS:528:DyaK2cXlslSjtL4%3D Occurrence Handle7513653
MS Paranka WF Walsh BB Stancombe (1992) ArticleTitleSurfactant lavage in a piglet model of meconium aspiration syndrome. Pediatr Res 31 625–628 Occurrence Handle1:CAS:528:DyaK38XksVSitL8%3D Occurrence Handle1635826
S Sasagawa (1991) ArticleTitleInhibitory effects of local anesthetics on migration, extracellular release of lyosomal enzyme, and superoxide anion production in human polymorphonuclear leukocytes. Immunopharmacol Immunotoxicol 13 607–622 Occurrence Handle1:CAS:528:DyaK38Xht1Snsrw%3D Occurrence Handle1663527
W Seeger A Günther HD Walmrath et al. (1993) ArticleTitleAlveolar surfactant and adult respiratory distress syndrome: pathogenic role and therapeutic prospects. Clin Invest 71 177–190 Occurrence Handle1:CAS:528:DyaK2cXmt1Ons7w%3D
SL Sood V Balaraman KC Finn et al. (1996) ArticleTitleExogenous surfactants in a piglet model of acute respiratory distress syndrome. Am J Respir Crit Care Med 153 1309–1315 Occurrence Handle8616559
RG Spragg (2000) ArticleTitleSurfactant replacement therapy. Clin Chest Med 21 IssueID3 531–541 Occurrence Handle1:STN:280:DC%2BD3cvmsFelsQ%3D%3D Occurrence Handle11019725
RG Spragg KW Harris J Lewis et al. (2001) ArticleTitleSurfactant treatment of patients with ARDS may reduce acute lung inflammation (abstract). Am J Respir Crit Care Med 163 A23
KP Steinberg LD Hudson (2000) ArticleTitleAcute lung injury and acute respiratory syndrome, the clinical syndrome. Clin Chest Med 21 401–417 Occurrence Handle1:STN:280:DC%2BD3cvmsFemtw%3D%3D Occurrence Handle11019717
W Strohmaier H Redl G Schlag (1990) ArticleTitleStudies of the potential role of a semi-synthetic surfactant preparation in an experimental aspiration trauma in rabbits. Exp Lung Res 16 101–110 Occurrence Handle1:CAS:528:DyaK3cXit12mtrw%3D Occurrence Handle2328709
Y Takao K Mikawa K Nishina et al. (1996) ArticleTitleLidocaine attenuates hyperoxic lung injury in rabbits. Acta Anaesthesiol Scand 40 318–325 Occurrence Handle1:CAS:528:DyaK28XislOntr8%3D Occurrence Handle8721462
LB Ware MA Mattnay (2000) ArticleTitleThe acute respiratory distress syndrome. N Engl J Med 342 1334–1349 Occurrence Handle1:STN:280:DC%2BD3c3jvFGhsw%3D%3D Occurrence Handle10793167
Acknowledgements
We thank the Dept. of Clinical Investigation for the use of their facilities and technical support, Ony Inc, for donating Infasurf surfactant, Dr Karen Thompson, Dept of Pathology, Kapiolani MC for her assistance in scoring the pathology specimens, and Dr. Timothy Haley, Tripler Army Medical Center for technical help and assistance with the experiments. Supported in part by NIH-RCMI, P20RR/11091, Advancing Newborn Medicine Fellowship Grant by Forest, Pharmaceuticals, Inc., Kapi’olani Children’s Miracle Network, and the Leahi Hawaii Community Foundation, Honolulu, HI. Infasurf donated by ONY, Inc, New York.
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Huang, T., Uyehara, C., Balaraman, V. et al. Surfactant Lavage with Lidocaine Improves Pulmonary Function in Piglets after HCl-Induced Acute Lung Injury . Lung 182, 15–25 (2004). https://doi.org/10.1007/s00408-003-1041-y
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DOI: https://doi.org/10.1007/s00408-003-1041-y