Combining Exogenous Surfactant or Perfluorocarbons with Inhaled Nitric Oxide to Improve Lung Function in Acute Respiratory Failure

Abstract

The acute respiratory distress syndrome (ARDS) is characterized by impaired ventilation-perfusion matching with severe hypoxemia [1]. In ARDS available treatments are still inadequate, and mortality and costs remain unacceptably high [1]. In the last decade, the morbidity and mortality rates of premature infants suffering from the respiratory distress syndrome have been decreased by exogenous surfactant therapy and this treatment is now routinely used in most neonatal intensive care units [2]. Surfactant abnormalities are also seen in adults with ARDS [3] . Therefore, it seems rational to administer exogenous surfactant in adults with ARDS, but the question then arises why this is not yet a reality [4]. Recently, Gregory and colleagues [5] reported that mortality could be decreased from 43.8 to 17.6% in patients with ARDS by instillation of 400 mg surfactant per kg body weight. At current prices, the cost of surfactant treatment for one adult would be above $ 75,000. This prohibitive price and the non-availability of large amounts of surfactant, make surfactant therapy not yet feasible in adults.