Intrabronchial surfactant application in cases of inhalation injury: First results from patients with severe burns and ARDS

Abstract

Damage to the respiratory tract caused by inhalation of toxic products of combustion with subsequent development of an acute respiratory distress syndrome (ARDS) is one of the main causes of death in burn patients. Treatment with an exogenous surfactant is a therapeutic option for which there has previously been no empirical data. We report on four severely burned patients with deep partial thickness and full thickness burns of between 40 and 70 per cent body surface area (BSA), and with inhalation injury complicated by ARDS. These patients were treated once or more than once with bovine surfactant replacement (Alveofact ®). In addition to biophysical and biochemical analysis, the influence of this substance on oxygenation and lung function were evaluated. After the limits of mechanical ventilation had been reached, bronchoscopic intrabronchial administration of surfactant was followed by temporarily improved gas exchange with an increase in arterial O 2 partial pressure ( PaO 2), accompanied by a reduction in inspiratory O 2 concentration ( FiO 2), and also improved lung compliance. All the patients survived in spite of an initially unfavourable prognosis. Replacement of exogenous surfactant in the treatment of inhalation traumatized severe burn patients with ARDS appears to show considerable promise as an approach to improving the survival chances of these high-risk patients.