SERUM SURFACTANT PROTEIN-A LEVELS IN PATIENTS WITH ACUTE CARDIOGENIC PULMONARY-EDEMA AND ADULT-RESPIRATORY-DISTRESS-SYNDROME

Detection of alveole-capillary damage has important implications for t reatment modalities in ventilated patients. Although surfactant protei n-A (SP-A) is normally only found in appreciable amounts in the lung, we describe significantly elevated concentrations in the sera of patie nts with acute cardiogenic pulmonary edema (median, 250 ng/ml; range, 180 to 364; n = 10) and in those with the adult respiratory distress s yndrome (ARDS) (median, 378 ng/ml; range, 215 to 1,378; n = 15) relati ve to healthy control subjects (median, 175 ng/ml; range, 123 to 248; n = 15) and ventilated patients with no cardiorespiratory disease (med ian, 169 ng/ml; range, 126 to 253; n = 6) (p < 0.01, in all cases). Se rum SP-A was inversely related to blood oxygenation and to static resp iratory system compliance both at the time of the patient's entry into the study (p < 0.005, r(s) = -0.51, n = 31; p < 0.001, r(s) = 0.82, n = 17; respectively) and during the course of admission (p < 0.001, r( s) = -0.34, n = 168; p < 0.001, r(s) = -0.50, n = 111; respectively). In addition, we describe in detail three cases of ARDS where lung func tion either improved, remained static, or deteriorated. We conclude th at serum SP-A is an acute indicator of lung function and alveolo-capil lary membrane injury.