INTRABRONCHIAL SURFACTANT APPLICATION IN POSTBURN SMOKE-INHALATION INJURY AND ADULT-RESPIRATORY-DISTRESS-SYNDROME - FIRST CASES

Damage to the respiratory system caused by inhalation of toxic product s of combustion and the subsequent development of adult respiratory di stress syndrome (ARDS) are the main lethal factors in burns patients. Treatment with exogenous surfactant is one of the therapeutic options. However, no clinical reports have yet been published about this thera py. We report on two patients with burn injuries of second to third d egree affecting 42% and 48% respectively of the total body surface plu s inhalation injury complicated by ARDS. Both patients were treated wi th bovine surfactant (Alveofact). The therapeutic effects on oxygenati on and pulmonary function were monitored. Intrabronchial application o f surfactant by bronchoscopy during exhaustive conventional mechanical ventilation resulted in improved gas exchange with an increase in art erial O-2 pressure (paO(2)); inspired O-2 concentration (FiO(2)) was l owered and there was an improvement in lung compliance. Both patients survived this critical situation. We conclude that treatment with exog enous surfactant in postburn victims with ARDS is a promising therapeu tic approach to improve the survival rate of these high-risk patients.