title: Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis.
abstract: The present study was performed on 10 patients with severe adult respiratory distress syndrome (ARDS), all suffering from sepsis (mean lung injury score [LIS] (1): 3.25 +/- 0.1; duration of mechanical ventilation upon study entry: 3.1 +/- 0.6 d). Ex vivo analysis of the alveolar surfactant system, obtained by bronchoalveolar lavage (BAL), showed severe impairment of surfactant function. Three hundred milligrams of natural surfactant/kg body weight (Alveofact) was delivered bronchoscopically in separate doses to each segment of both lungs. This caused an immediate increase in PaO2/FlO2 from 85 +/- 7 mm Hg to 200 +/- 20 mm Hg (p < 0.001), mainly due to a decrease in shunt flow (42 +/- 4 to 20 +/- 2% [p < 0.001]). Reanalysis of the alveolar surfactant showed that its function was significantly improved. In five patients the increase in arterial oxygenation was partially lost within the next few hours, and a second dose of 200 mg/kg surfactant was applied 18 to 24 h later, again increasing PaO2/FlO2 values. Eight patients survived the subsequent 14-d observation period with progressive improvement of gas exchange, and five patients were definitely weaned from the respirator. All fatalities were due to non-respiratory causes. We conclude that the bronchoscopic application of a high dose of surfactant aimed at overcoming inhibitory factors in the alveolar space of these patients, may offer a feasible and safe approach to improving gas exchange in severe ARDS.
authors.affiliation: Department of Medicine, Justus-Liebig University, Giessen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Walmrath
authors.forename: A
authors.initials: A
authors.lastname: Günther
authors.forename: H A
authors.initials: HA
authors.lastname: Ghofrani
authors.forename: R
authors.initials: R
authors.lastname: Schermuly
authors.forename: T
authors.initials: T
authors.lastname: Schneider
authors.forename: F
authors.initials: F
authors.lastname: Grimminger
authors.forename: W
authors.initials: W
authors.lastname: Seeger
mesh_terms: D000293:Adolescent; D000328:Adult; D001999:Bronchoscopy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008055:Lipids / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011652:Pulmonary Circulation; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics; D018805:Sepsis / Q000150:complications*; D014692:Ventilation-Perfusion Ratio
chemical_list: D008055:Lipids; D010743:Phospholipids; D011663:Pulmonary Surfactants; C078272:SF-RI 1, bovine surfactant preparation