Low volume ventilation without periodic large inflations leads to diminished alveolar stability and to the accumulation of increased amounts of airway disaturated phosphatidylcholine (DSPC) in large aggregates that sediment at 1,000 g; surfactant in this form lowers surface tension less rapidly than surfactant present in the 1,000-g supernatant fraction. These observations led to the present work in which we tested the notion that alveolar instability may develop in the presence of an undiminished quantity of total airway surfactant, if the amount of surfactant found in the 1,000-g supernatant fraction is diminished. Pulmonary compliance fell and the alveolar-arterial O2 gradient widened in normothermic rats during constant ventilation in the resting tidal volume range, and, in hyperthermic rats (~39°C) similarly ventilated but with the addition of periodic sighs. The total amount of airway DSPC was undiminished in each group, but in each less DSPC was present in 1,000-g supernatant fraction compared with controls. Alveolar instability and hypoxemia also developed in hyperthermic rats during low volume ventilation without periodic sighs. Although the total amount of airway DSPC was decreased in these rats, enough remained to theoretically form a continuous monomolecular film over the entire alveolar surface at functional residual capacity; however, there was insufficient surfactant in the 1,000-g supernatant fraction to form such a continuous film. These findings demonstrate that the mode of ventilation, and moderate hyperthermia, may lead to decreased alveolar stability despite the presence of normal amounts of airway surfactant, and, by inference, indicate the extracellular form or state of surfactant has an important effect on alveolar stability.
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