EXOGENOUS SURFACTANT THERAPY IN A PATIENT WITH ADULT-RESPIRATORY-DISTRESS-SYNDROME AFTER NEAR-DROWNING

A 24-year-old woman developed adult respiratory distress syndrome (ARD S) after near-drowning due to attempted suicide. Conventional mechanic al ventilation together with prone positioning and inhaled nitric oxid e could not provide sufficient oxygenation. Surface tension data (gamm a min = 27 dyn/cm, stability index = 0.341) from a lavage sample suppo rted the hypothesis that the surfactant function of this patient was d rastically reduced due to a washout effect by aspiration of fresh wate r. Porcine surfactant (Curosurf(R), 50 mg/kg for each lung) was instil led via fibreoptic bronchoscope. The partial arterial carbon dioxide p ressure (paCO(2)) and fraction of inspired oxygen (FiO(2)) ratio as we ll as shunt fraction (Qs/Qt) improved impressively. When respiratory s ituation deteriorated again, surfactant application was repeated. Alto gether, six bolus instillations of surfactant (total dose 300 mg/kg = 18 000 mg) were administered until the respiratory situation had stabi lized and oxygenation could be maintained by conventional mechanical v entilation. The radiological findings did not show substantial amelior ation. The patient developed septic shock and died 12 days after admis sion. Surfactant application apparently led to a significant improveme nt of the respiratory function. However, the outcome could not be infl uenced positively. The high cost of surfactant therapy prevents the mo re widespread early administration in patients at risk. (C) 1997 Elsev ier Science Ireland Ltd.