BRONCHOSCOPIC SURFACTANT ADMINISTRATION IN PATIENTS WITH SEVERE ADULT-RESPIRATORY-DISTRESS-SYNDROME AND SEPSIS

The present study was performed on 10 patients with severe adult respi ratory distress syndrome (ARDS), all suffering from sepsis (mean lung injury score [LIS] (1): 3.25 +/- 0.1; duration of mechanical ventilati on upon study entry: 3.1 +/- 0.6 d). Ex vivo analysis of the alveolar surfactant system, obtained by bronchoalveolar lavage (BAL), showed se vere impairment of surfactant function. Three hundred milligrams of na tural surfactant/kg body weight (Alveofact(R)) was delivered bronchosc opically in separate doses to each segment of both lungs. This caused an immediate increase in Pa-O2/Fl(O2) from 85 +/- 7 mm Hg to 200 +/- 2 0 mm Hg (p < 0.001), mainly due to a decrease in shunt flow (42 +/- 4 to 20 +/- 2% [p < 0.001]). Reanalysis of the alveolar surfactant showe d that its function was significantly improved. In five patients the i ncrease in arterial oxygenation was partially lost within the next few hours, and a second dose of 200 mg/kg surfactant was applied 18 to 24 h later, again increasing Pa-O2/Fl(O2). values. Eight patients surviv ed the subsequent 14-d observation period with progressive improvement of gas exchange, and five patients were definitely weaned from the re spirator. All fatalities were due to nonrespiratory causes. We conclud e that the bronchoscopic application of a high dose of surfactant, aim ed at overcoming inhibitory factors in the alveolar space of these pat ients, may offer a feasible and safe approach to improving gas exchang e in severe ARDS.