Surfactant replacement for ventilator-associated pneumonia: a preliminary report.
BACKGROUND
Surfactant abnormalities have been described in bacterial pneumonia.


OBJECTIVE
To determine the safety and effect of exogenous surfactant replacement in patients with ventilator-associated pneumonia (VAP).


METHODS
Patients with VAP were randomized in a double-blind study to receive either an artificial surfactant (Exosurf) consisting mostly of disaturated phospholipids (DSPL) or saline via a continuous nebulizer system for 5 days. Patients underwent bronchoscopy and bronchoalveolar lavage (BAL) prior to and after 4 days of therapy.


RESULTS
Twenty-two patients were randomized, with 8 receiving Exosurf. There was no detected difference in outcome between the saline- and Exosurf-treated patients in terms of days on ventilator, 30-day or hospital mortality. At the follow-up lavage, the patients treated with Exosurf had a significant rise in the level of DSPL (p < 0.05), while the saline group did not, suggesting delivery of drug. Also at the follow-up lavage, the percentage of neutrophils in the BAL fell in the Exosurf patients (p < 0.01), but not in the saline group.


CONCLUSIONS
Exogenous surfactant replacement given to patients with VAP increased the amount of DSPL retrieved by BAL. This treatment was associated with a fall in the neutrophil response to pneumonia.
Baughman
Robert P
RP
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0564, USA. bob.baughman@uc.edu
Henderson
Rogene F
RF
Whitsett
Jeffrey
J
Gunther
Karen L
KL
Keeton
Deborah A
DA
Waide
James J
JJ
Zaccardelli
David S
DS
Pattishall
Edward N
EN
Rashkin
Mitchell C
MC
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D001999:Bronchoscopy; D004311:Double-Blind Method; D004338:Drug Combinations; D005233:Fatty Alcohols / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010767:Phosphorylcholine; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011336:Probability; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012016:Reference Values; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012129:Respiratory Function Tests; D012965:Sodium Chloride / Q000008:administration & dosage; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D004338:Drug Combinations; D005233:Fatty Alcohols; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; D012965:Sodium Chloride; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination