INTRABRONCHIAL SURFACTANT APPLICATION IN CASES OF INHALATION INJURY -FIRST RESULTS FROM PATIENTS WITH SEVERE BURNS AND ARDS

Damage to the respiratory tract caused by inhalation of toxic products of combustion with subsequent development of an acute respiratory dis tress syndrome (ARDS) is one of the main causes of death in burn patie nts. Treatment with an exogenous surfactant is a therapeutic option fo r which there has previously been no empirical data. We report on four severely burned patients with deep partial thickness and full thickne ss burns of between 40 and 70 per cent body surface area (BSA), and wi th inhalation injury complicated by ARDS. These patients were treated once or more than once with bovine surfactant replacement (Alveofact(R )). In addition to biophysical and biochemical analysis, the influence of this substance on oxygenation and lung function were evaluated. Af ter the limits of mechanical ventilation had been reached, bronchoscop ic intrabronchial administration of surfactant was followed by tempora rily improved gas exchange with an increase in arterial O-2 partial pr essure (PaO2), accompanied by a reduction in inspiratory O-2 concentra tion (FiO(2)), and also improved lung compliance. All the patients sur vived in spite of an initially unfavourable prognosis. Replacement of exogenous surfactant in the treatment of inhalation traumatized severe burn patients with ARDS appears to show considerable promise as an ap proach to improving the survival chances of these high-risk patients. (C) 1998 Elsevier Science Ltd for ISBI. All rights reserved.