The adult respiratory distress syndrome: first trials with surfactant replacement

Following diverse insults, patients may develop a high permeability lung oedema which results in tachypnoea, cyanosis, hypoxaemia, and pan-lobar infiltrates on the chest radiograph. Although a variety of interventional therapies have been evaluated, none has been found effective, and current treatments are entirely supportive. Recently, cellular and biochemical analyses of bronchoalveolar lavage fluid have disclosed abnormalities which suggest that acute inflammatory events and surfactant abnormalities are present in the lungs of patients with adult respiratory distress syndrome (ARDS). The similarities to abnormalities seen in neonates with respiratory distress syndrome are striking. Treatment of those infants with surfactant replacement has been of both short-term and long-term benefit. Therefore, it is rational to investigate the benefits which surfactant administration may have for patients with ARDS. We present an overview of ARDS, and our initial experience with surfactant replacement in three patients.