The effect of exogenous surfactant in patients with lung contusions and acute lung injury.
OBJECTIVE
To investigate the acute effect of surfactant replacement in multiple-trauma patients with lung contusion and acute lung injury.


METHODS
Prospective randomized clinical trial in the 14-bed ICU of a 750-bed university hospital.


METHODS
Sixteen ventilated trauma patients with severe refractory hypoxemia (PaO(2)/FIO(2)<150 mmHg) and lung contusions.


METHODS
Patients were randomly assigned to either surfactant administration (n=8) or standard treatment (n=8). A single dose of natural bovine surfactant was instilled bronchoscopically in the involved lung areas; each segmental bronchus received (200/19) mg/kg body weight.


RESULTS
The surfactant group demonstrated an acute improvement in oxygenation after surfactant replacement compared both to control group and to baseline values. In the surfactant group PaO(2)/FIO(2) increased from 100+/-20 mmHg at baseline to 140+/-20 (6 h), 163+/-26 (12 h), and 187+/-30 mmHg (24h). Compliance increased from 30 to 36 ml/cmH(2)O at 6 h after administration, and this increase remained significant at the 24, 48, and 72 h time points. The surfactant group demonstrated a higher response to recruitment maneuvers than the control group at 6 h. The mean duration of ventilatory support was 5.6 +/-2.6 days in the surfactant group and 8.1+/-2.4 days in the control group.


CONCLUSIONS
Surfactant replacement was well tolerated in patients with lung contusions and severe hypoxemia and resulted in improved oxygenation and compliance.
Tsangaris
I
I
Intensive Care Unit, University Hospital of Ioannina, University Street, 45500, Ioannina, Greece.
Galiatsou
E
E
Intensive Care Unit, University Hospital of Ioannina, University Street, 45500, Ioannina, Greece.
Kostanti
E
E
Intensive Care Unit, University Hospital of Ioannina, University Street, 45500, Ioannina, Greece.
Nakos
G
G
Intensive Care Unit, University Hospital of Ioannina, University Street, 45500, Ioannina, Greece. gnakos@cc.uoi.gr.
D018806:APACHE; D000328:Adult; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D015601:Injury Severity Score; D008875:Middle Aged; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000628:therapy*; D013501:Surface-Active Agents / Q000627:therapeutic use*
D013501:Surface-Active Agents