EFFECT OF SURFACTANT ON RESPIRATORY-FAILURE ASSOCIATED WITH THORACIC ANEURYSM SURGERY

Objective: To study the effects of surfactant administration on the le ft lung after surgical repair of descending aortic aneurysms on postop erative respiratory failure. Design: Randomized, prospective, controll ed study. Setting: Clinical investigation. Patients: Eleven patients w ith respiratory failure associated with thoracic aneurysm surgery. Int ervention: Eleven adult-patients with acute respiratory failure (Pao(2 )/Flo(2) <300 torr [<40 kPa]) after surgical repair of descending aort ic aneurysms. The artificial surfactant (30 mg/kg) was given to the op erated side of the lung by intrabronchial instillation in six patients (surfactant group), whereas nothing was instilled in the other five p atients (control group). Measurements and Main Results: Hemodynamic pa rameters, blood gas, and peak inspiratory pressure were measured at th e end of surgery, before surfactant instillation, and at 2, 6, 12, 24, and 48 hrs after surfactant instillation. At the end of surgery, the mean +/- SEM values of the Pao(2)/Flo(2) ratio were 204 +/- 25 torr (2 7.2 +/- 3.3 kPa) in the surfactant group and 240 +/- 26 torr (32.0 +/- 3.5 kPa) in the control group. After 2, 6, 12, and 48 hrs, improvemen ts in the Pao(2)/Flo(2) ratios were observed in the surfactant group, whereas the control group showed no improvement. Two hours after surfa ctant instillation, the mean value in the Pao(2)/Flo(2), ratio was sig nificantly higher in the surfactant group (318 +/- 24 torr [42.4 +/- 3 .2 kPa]) (p < .05) compared with the control group values (240 +/- 34 torr [32 +/- 4.5 kPa]). Conclusion: Surfactant administration immediat ely after surgery restored gas exchange in postoperative respiratory f ailure associated with thoracic aneurysm surgery.