Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 295-303 (doi:10.1542/peds.2005-0378)
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Acute and Sustained Effects of Lucinactant Versus Poractant-{alpha} on Pulmonary Gas Exchange and Mechanics in Premature Lambs With Respiratory Distress Syndrome

Elena Gastiasoro-Cuesta, MDa, Francisco J. Alvarez-Diaz, PhDa, Carmen Rey-Santano, PhDa, Arantxa Arnaiz-Renedo, PhDa, Begoña Loureiro-Gonzalez, MDb and Adolf Valls-i-Soler, MDb

a Research Unit for Experimental Neonatal Respiratory Physiology, Department of Pediatrics, Hospital Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain
b Neonatal Intensive Care Unit, Department of Pediatrics, Hospital Cruces, University of the Basque Country, Barakaldo, Bizkaia, Spain

BACKGROUND. Animal-derived, protein-containing surfactants seem to be superior to protein-free surfactants. Lucinactant, a synthetic surfactant containing a surfactant protein-B peptide analog, has been shown to be effective in animal models and phase II clinical trials. To date, lucinactant has not been compared with an animal-derived surfactant in a premature animal model.

OBJECTIVE. The objective was to compare the acute and sustained effects of lucinactant among premature lambs with respiratory distress syndrome (RDS) with the effects of a natural porcine surfactant (poractant-{alpha}).

METHODS. After 5 minutes of mechanical ventilation twin premature lambs were assigned randomly to the lucinactant group (30 mg/mL, 5.8 mL/kg) or the poractant-{alpha} group (80 mg/mL, 2.2 mL/kg). Heart rate, systemic arterial pressure, arterial pH, blood gas values, and lung mechanics were recorded for 12 hours.

RESULTS. Baseline fetal pH values were similar for the 2 groups (pH 7.27). After 5 minutes of mechanical ventilation, severe RDS developed (pH: <7.08; PaCO2: >80 mm Hg; PaO2: <40 mm Hg; dynamic compliance: <0.08 mL/cm H2O per kg). After surfactant instillation, similar improvements in gas exchange and lung mechanics were observed for the lucinactant and poractant-{alpha} groups at 1 hour (pH: 7.3 ± 0.1 vs 7.4 ± 0.1; PaCO2: 8 ± 18 mm Hg vs 40 ± 8 mm Hg; PaO2: 167 ± 52 mm Hg vs 259 ± 51 mm Hg; dynamic compliance: 0.3 ± 0.1 mL/cm H2O per kg vs 0.3 ± 0.1 mL/cm H2O per kg). The improvements in lung function were sustained, with no differences between groups. Cardiovascular profiles remained stable in both groups.

CONCLUSIONS. Among preterm lambs with severe RDS, lucinactant produced improvements in gas exchange and lung mechanics similar to those observed with a porcine-derived surfactant.

Key Words: natural surfactant • synthetic surfactant • respiratory distress syndrome • premature lambs

Abbreviations: FIO2—fraction of inspired oxygen • MAP—mean airway pressure • OI—oxygenation index • PEEP—positive end-expiratory pressure • PIP—peak inspiratory pressure • RDS—respiratory distress syndrome • SP—surfactant protein

Accepted May 5, 2005.




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