Aerosolized Surfactant in Adults with Sepsis-Induced Acute Respiratory Distress Syndrome

Abstract

The continuous administration of aerosolized synthetic surfactant to patients with sepsis-induced ARDS had no significant effect on 30-day survival, length of stay in the intensive care unit, duration of mechanical ventilation, or physiologic function.

Surfactant for Pediatric Acute Lung Injury

“…This is also the conclusion of retrospective meta analyses combining clinical data from multiple surfactant trials [170][171][172][173][174]. As noted earlier, the largest study of surfactant therapy in adults with ALI/ARDS utilized the protein-free synthetic surfactant Exosurf® and found no therapeutic benefit [136]. The hydrophobic surfactant proteins are highly-active in endogenous surfactant, and substituting for them effectively in protein-free synthetic surfactants is extremely difficult.…”

“…In theory, aerosolization could significantly reduce required surfactant doses, since delivery can be targeted to the alveoli by controlling particle size. Phospholipid aerosols with stable particle sizes appropriate for alveolar deposition in normal lungs can be formed by ultrasonic or jet nebulization [150,156,157], and exogenous surfactants have been aerosolized to animals and patients with surfactant deficiency or dysfunction [91,105,110,136,[158][159][160]. However, the theoretical potential of aerosols to improve alveolar deposition and reduce required surfactant doses has not been replicated in practice.…”

“…However, many of these are small case series or pilot studies, and found only improvements in acute lung function (oxygenation). Controlled trials of surfactant therapy in patients with ALI/ARDS have met with mixed success, particularly in adults with sepsis-associated ARDS [136,137]. A summary of the clinical experience with exogenous surfactant therapy in term infants, children and adults is given below.…”

“…However, particularly in adults, controlled clinical trials have been less successful. By far the largest prospective controlled study of surfactant therapy in adults with ARDS was definitively negative [136]. Anzueto et al [136] administered nebulized Exosurf® vs. placebo to 725 adults with ARDS secondary to sepsis and found no improvement in any measure of oxygenation and no effect on morbidity or mortality.…”

“…By far the largest prospective controlled study of surfactant therapy in adults with ARDS was definitively negative [136]. Anzueto et al [136] administered nebulized Exosurf® vs. placebo to 725 adults with ARDS secondary to sepsis and found no improvement in any measure of oxygenation and no effect on morbidity or mortality. However, interpretation of these negative results is confounded because both laboratory and clinical studies have documented that Exosurf® has low activity compared to animal-derived surfactants [51, [113][114][115][116][117][142][143][144][145], and aerosolization has not been shown to be as effective as airway instillation in delivering surfactant.…”