SURFACTANT REPLACEMENT THERAPY IN ARDS - WHITE KNIGHT OR NOISE IN THESYSTEM

Although one would predict that surfactant replacement therapy would b e effective in acute respiratory distress syndrome (ARDS), a recent la rge trial proved unsuccessful, possibly reflecting the nature of the s urfactant used. Given the importance of the unique proteins in the act ion of surfactant, these would seem vital components of any exogenous surfactant. The ability to identify patients at risk of ARDS and to ch aracterise their surfactant might allow prophylactic treatment with a nebulised, complementary, tailor-made preparation of surfactant. Advan ced cases might undergo bronchoscopic focal lavage to remove plasma pr oteins and inflammatory mediators prior to focal instillation of surfa ctant to areas of greatest need. Ventilation regimens might be adjuste d both to minimise trauma and to conserve endogenous surfactant.