We have previously shown that manual ventilation with a few large breaths(35-40 ml/kg) at birth compromises the effect of subsequent surfactant treatment in immature lambs [Acta Anaesthesiol Scand 1995;39(suppl 105):153]. We now studied if also smaller lung inflations would damage the surfactant-deficient lung. Lambs with gestational age 126-128 days were randomized to five different treatment schedules with Curosurf (C) 200 mg/kg: 1) C mixed with lung liquid before birth, 2) C after birth, but before the first breath. and 3-5) five sustained lung inflations (8, 16 and 32 ml/kg, respectively) at birth, immediately followed by C. The lambs were then mechanically ventilated, and blood gases, lung volumes and deflation pressure-volume curves of the respiratory system were recorded regularly during 4 h. There was no significant difference in oxygenation between the groups, but the other lung function parameters indicated an increase in lung injury in relation to the volume of early lung inflations. The lambs given the smallest lung inflations (group 3), still had a 38% reduction of static compliance at 4 h as compared to lambs in group 1. We conclude that even modest inflations of surfactant-deficient lungs during resuscitation may cause significant lung injury. Figure

figure 1

Figure 1