Surfactant replacement therapy in acute respiratory distress syndrome from viral pneumonia

Abstract

A modified natural surfactant was administered to a patient with life-threatening adult respiratory distress syndrome caused by viral pneumonia. Subsequently, there was a marked improvement in gas exchange. In order to assess the mechanism for improved oxygenation, computed tomography of the lungs was done. Quantitative analysis of the scans taken before and after surfactant administration indicates that improvement in gas exchange was largely due to the expansion of underinflated and collapsed lung areas. Although this is a single case report, it provides insight into the possible beneficial effect of instilled surfactant in severe respiratory distress from viral pneumonia.

First clinical experiences with exogenous surfactant therapy

“…Gas exchange improved and peak ventilation pressure could be reduced. Putz et al confirmed the successful treatment of ARDS, caused by viral pneumonia, using a natural surfactant (200 mg/kg)[26]. Slater et al reported an infant with Pneumocystis carinii pneumonia associated ARDS who failed to respond to standard therapy, including corticosteroids, but improved dramatically with artificial surfactant (40 mg/kg)[29].Mikawa et al showed an improvement of oxygenation after selective instillation of exogenous surfactant in lobar bacterial pneumonia[23].…”