Surfactant Aerosol

Instillation of surfactant improves outcome in premature infants with neonatal respiratory distress. Loss of surfactant is probably a contributing factor in pathogenesis of acute respiratory distress syndrome in adults, so there has been an interest in the use of surfactant, by either bolus instillation or aerosol, to treat that disorder. Because of the desire to try to improve lung delivery and distribution, there is interest in exploring aerosol delivery. Early, small studies suggested an efficacy of surfactant aerosol for ARDS [172], but more recent, larger controlled trials have failed to document any survival benefit [173,174].

Surfactant aerosol also has been tested in chronic bronchitis; the modest improvement in FEV1 was small, and its expense would not justify use based on these data [175]. In tests of aerosol surfactant in adults with CF treated over 5 days, no improvement was found [176]. Although instilled surfactant has become common practice for the neonatal respiratory distress of premature infants, aerosol delivery is not yet adequately developed. A recent study showed no difference in outcome for spontaneously breathing newborns who inhaled either surfactant or placebo via a CPAP mask [177]. There continues to be great appeal for the use of surfactant in adults because of the apparent success in neonates, but its use should not become practice until well-controlled trials document clinically meaningful efficacy.

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