[Intrabronchial surfactant administration in inhalation trauma of severely burned patients with ARDS. Initial case...

Damage to the respiratory system caused by inhalation of toxic products of combustion and the subsequent development of adult respiratory distress 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 therapy. We report on two patients with burn injuries of second to third degree affecting 42% and 48% respectively of the total body surface plus inhalation injury complicated by ARDS. Both patients were treated with bovine surfactant (Alveofact). The therapeutic effects on oxygenation and pulmonary function were monitored. Intrabronchial application of surfactant by bronchoscopy during exhaustive conventional mechanical ventilation resulted in improved gas exchange with an increase in arterial O2 pressure (paO2); inspired O2 concentration (FiO2) was lowered and there was an improvement in lung compliance. Both patients survived this critical situation. We conclude that treatment with exogenous surfactant in postburn victims with ARDS is a promising therapeutic approach to improve the survival rate of these high-risk patients.