Clinical trials and pilot studies on exogenous surfactant supplementation

• Acute Lung Injury (ALI)

  • Thoracic trauma
  • Inhalation / aspiration syndrome

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Fascinating and stimulating new indications for surfactant supplementation in lung disfunction from different origins are under study. In several clinical conditions inside the lung foreign material is present and can inhibit surfactant activity and favour alveolar collapse and over-infection.

In thorax trauma, contusion of the lung can be present and the damaged lung may not only present a reduction in the ventilated areas but also deteriorated matter (destroyed vessels, alveoli, bronchioli, red cells, fibrine, etc.) that inactivate the surfactant. Also in inhalation syndrome regurgitated matter reaches the trachea and bronchi (e.g. Mendelson syndrome) creating a life-threatening acute phase similar to meconium aspiration syndrome in newborns. This phase can be followed by migration of inhaled matter from the large bronchi towards the smaller, closing them and compromising ventilation. Chemical pneumonia and bacterial over-infection may follow and become clearly evident from 24-36 hours. This risk requires constant monitoring during the first 48 hours after inhalation.

Rapid removal of inhaled matter was for a long time carried out by saline BAL. Saline solution is not a good carrier of gases (particularly oxygen) and the diluted matter can be more rapidly absorbed, thus deteriorating gas exchange. On the other hand there is great optimism regarding the use of PFC BAL due to the particular characteristics of perfluorocarbons (inert and not mixing with water or organic liquids, good carrier of gases). Marraro et al 1998.

Diluted surfactant BAL is under study by our group, following the method recommended by Lam et al. In our ongoing research, better results have been obtained supplementing 50/mg kg of bolus surfactant after BAL. Preliminary and unpublished data.

Marraro G, Bonati M , Ferrari A, Barzaghi MM, Pagani C, Bartolotti A, Galbiati A, Luchetti M, Croce a. Intensive Care Med 1998

Foust R III, Tran NN, Cox C, Miller TF, Greenspan JS, Wolfson MR, Shaffer TH. Pediatr Pulmonol 1996