Table 8.
Surfactant replacement therapy by aerosol delivery for various pulmonary disorders.
| Surfactant | Dose delivered | Delivery method | Aerosol particle size | Amount deposited | Disease (model) | Notes | Ref. |
|---|---|---|---|---|---|---|---|
| Synthetic DPPC | 0.25% | Inhalation | 0.25 μm | N/A | NRDS (infant) | Inconclusive results needing further study | [41] |
| Synthetic DPPC | 1% | MHz ultrasonic generator | N/A | N/A | NRDS (infant) | The study estimated that 3 mg /kg DPPC could provide an alveolar monolayer | [61] |
| DPPC/DPPG (9:l) | N/A | Nebulizer | N/A | N/A | NRDS (infant) | An improvement in the level of PL but not a coincidental improvement in the disease | [42] |
| Pure DPPC and PG | 25 mg powder in capsule | Modified bag† | 100 μm | N/A | NRDS (infant) | Surfactant dry powder blow down ETT Substantially less improvement compared with that attained with animal or human surfactant |
[44] |
| [3H] Survanta® | Approximately 875 mg PL (Tot Lav-Neb)‡ | Actuated nebulizer | MMAD = 2–3 μm GSD = 1.9–2.1 |
105 ± 7 mg PL (Tot Lav-Neb) | ARDS with pattern of ALI (adult sheep) | No major changes in ventilation-perfusion matching as measured at the lobar level Underlying pattern of ALI affected surfactant distribution and hence, physiologic responses to the surfactant therapy More aerosolized surfactant deposited in the injured lung improved physiologic response |
[62] |
| [3H] Survanta | Approximately 800 mg PL (Par Lav-Neb)§ | Actuated nebulizer | MMAD = 2–3 μm GSD = 1.9–2.1 |
79 ± 7 mg PL (Par Lav-Neb) | ARDS with pattern of ALI (adult sheep) | No major changes in ventilation-perfusion matching as measured at the lobar level Underlying pattern of ALI affected surfactant distribution and hence, physiologic responses to the surfactant therapy More aerosolized surfactant deposited in the injured lung improved physiologic response |
[62] |
| Exosurf® | 240 ml of 13.5 mg/ml PL | Visan-9 nebulizer | N/A | >5 mg the dose of 112 mg PL/kg/day | Sepsis induced ARDS (adult) | No improvement in oxygenation, peak airway pressure, or overall survival at 30 days No reduction in the time required for MV, the need for oxygen supplementation, or the length of the stay in the ICU or the hospital |
[100] |
| Surfactant from fresh sheep lung | 10 ml of 15 mg/ml surfactant | Ultrasonic nebulizer | MMD = 0.44 μm and initial particle diameter = 2.40 μm | N/A | Preterm neonatal rabbit | An initial oropharyngeal dose of surfactant (50 μl of 30 mg/ml PL) was given A dried, hygroscopic aerosol is an effective means of surfactant delivery to spontaneously breathing premature rabbit neonates |
[11] |
| [99mTc] Alveofact® | 2 ml of of 45 mg/ml surfactant | Three jet nebulizers | 70% = 1–5 μm¶ | 10% for MiniNEB & 1–3% for Intersurgical and Flo-Thru nebulizers | Lung-lavaged rabbit | No change in surfactant composition and biophysical properties by nebulization Low nebulization efficiency as most surfactant aerosol is deposited in the expiratory tubing The particle size distribution of the surfactant aerosol as produced by MiniNEB ensures a peripheral deposition in the lungs Nebulization is feasible, but improving the efficiency of the procedure is needed |
[106] |
| Alveofact | 2.4 ml of 120 mg surfactant | Jet nebulizer | 75% <5μm# MMAD = 3.4 μm GSD = 1.7 |
N/A | CF (adult) | No significant acute or short-term effect Insufficient quantity delivered, non-uniform distribution or inhibition of the surfactant in the lungs may be reasons for a lack of effect |
[110] |
| Curosurf® | 480 mg | A modified Aiolos® nebulizer + CPAP support | N/A | N/A | NRDS (infant) | No beneficial effects of aerosolized surfactant contrary to data from animal experiments Selective deposition of highly surfactant aggregates from the aerosol, or better surfactant distribution may be reasons |
[56] |
| Surfaxin® | 72 mg PL over 3 h | Vibrating mesh nebulizer + CPAP | MMAD = 1.9 ± 0.3 μm | N/A | NRDS (infant) | Safe and well tolerated Lack of efficiency as there was no control group included |
[102] |
Modified bag: Modified Laerdal neonatal resuscitation bag with attachment to hold capsule size 2 of artificial surfactant.
Tot Lav-Neb: Total lung lavage group treated with 32 ± 2 ml nebulized surfactant.
Par Lav-Neb: Partial lung lavage group treated with 35 ± 2 ml nebulized surfactant.
70% = 1–5 μm: 70% of the particle have particle diameter ranged from of 1–5 μm.
75% <5μm: 75% of the particle have particle diameter less than of <5μm.
ALI: Acute lung injury; ARDS: Acute respiratory distress syndrome; CF: Cystic fibrosis; CPAP: Continuous positive airway pressure; DPPC: Dipalmitoylphosphatidylcholine; DPPG: Dipalmitoylphosphatidylglycerol; ETT: Endotracheal tube; GSD: Geometric standard deviation; ICU; Intensive care unit; MMAD: Mass median aerodynamic diameter; MV: Mechanical ventilation; NRDS: Neonates with respiratory distress syndrome; PG: Phosphatidylglycerol; PL: Phospholipids.