The effects of synthetic and natural surfactant on fluid balance in acute respiratory distress syndrome

To evaluate the effect of different surfactants on fluid balance in respira tory distress syndrome, we studied 24 premature infants who were randomised to receive either natural or synthetic surfactant. Data were collected on ventilatory parameters, daily urine output, daily weight, fluid intake and serum electrolytes. Ventilatory requirements decreased more rapidly in babi es receiving natural surfactant, with significantly greater reductions in m ean airway pressure from 1 to 48 h and oxygenation index from 1-18 h (P < 0 .05). There were no differences in fluid intake and serum electrolytes. Mea n daily urine output was higher in the group receiving natural surfactant ( 87 ml versus 61 ml, P < 0.05). This group also had a greater weight loss fr om birth weight (-146 g versus -65 g, P < 0.05). Conclusion Natural surfactant produces an earlier reduction in ventilatory requirements with an earlier diuresis. This should influence fluid manageme nt in respiratory distress syndrome.