Acute and sustained effects of lucinactant versus poractant-alpha on pulmonary gas exchange and mechanics in premature lambs with respiratory distress syndrome.

Abstract

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.

• Authors: Elena Gastiasoro-Cuesta, Francisco J Alvarez-Diaz, Carmen Rey-Santano, Arantxa Arnaiz-Renedo, Begoña Loureiro-Gonzalez, Adolf Valls-i-Soler
• Journal: Pediatrics (Pediatrics) Vol. 117 Issue 2 Pg. 295-303 (Feb 2006) ISSN: 1098-4275 [Electronic] United States
• PMID: 16452346 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biological Products
• Drug Combinations
• Fatty Alcohols
• Phosphatidylglycerols
• Phospholipids
• Proteins
• lucinactant
• poractant alfa

Topics

• Animals
• Animals, Newborn
• Biological Products (therapeutic use)
• Blood Gas Analysis
• Blood Pressure
• Drug Combinations
• Fatty Alcohols (therapeutic use)
• Gestational Age
• Heart Rate
• Humans
• Infant, Newborn
• Phosphatidylglycerols (therapeutic use)
• Phospholipids (therapeutic use)
• Proteins (therapeutic use)
• Pulmonary Gas Exchange
• Respiratory Distress Syndrome, Newborn (drug therapy, physiopathology)
• Sheep