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Using bolus instillation it is possible to deliver large dose in order to obtain a rapid delivery and response. Surfactant distribution is not uniform and liquid bolus can obstruct the endotracheal tube and airways. Symptoms similar to near-drowning syndrome resulting from stimulation of vagal reflexes can be consequent to instillation of large doses of surfactant intratracheally. Such symptoms are less evident using concentrated surfactant.
Surfactant aerosolization gives gentle delivery and more uniform distribution especially in the case of homogeneous lung injury. Possible disadvantages are connected with inefficient delivery from ventilatory circuit (as little as 5% of the dose may reach alveoli) and rapid inactivation due to slow delivery of quantities.
Lewis J, Ikegami M, Higuchi R, Jobe A, Absolom D. J Appl Physiol 1991
Lewis J, Tabor B, Ikegami M, Jobe A, Joseph M, Absolom D. J Appl Physiol 1993
MacIntyre NR, Coleman RE, Schuller FS, Zacardelli D, Pattishall E. Am Rev Resp Dis 1994
Schermuly R, Schmehl T, Gunther A, Grimminger F, Seeger W, Walmrath D. Am J Resp Crit Care Med 1997
