The effect of exogenous surfactant in patients with lung contusions and acute lung injury

Objective: To investigate the acute effect of surfactant replacement in multiple-trauma patients with lung contusion and acute lung injury. Design and setting: Prospective randomized clinical trial in the 14-bed ICU of a 750-bed university hospital. Patients and participants: Sixteen ventilated trauma patients with severe refractory hypoxemia (PaO2/FIO2 < 150 mmHg) and lung contusions. Interventions: Patients were randomly assigned to either surfactant administration (n = 8) or standard treatment (n = 8). A single dose of natural bovine surfactant was instilled bronchoscopically in the involved lung areas; each segmental bronchus received (200/19) mg/kg body weight. Measurements and results: The surfactant group demonstrated an acute improvement in oxygenation after surfactant replacement compared both to control group and to baseline values. In the surfactant group PaO2/FIO2 increased from 100 +/- 20 mmHg at baseline to 140 +/- 20 (6 h), 163 +/- 26 (12 h), and 187 +/- 30 mmHg (24 h). Compliance increased from 30 to 36 ml/cmH(2)O at 6 h after administration, and this increase remained significant at the 24, 48, and 72 h time points. The surfactant group demonstrated a higher response to recruitment maneuvers than the control group at 6 h. The mean duration of ventilatory support was 5.6 +/- 2.6 days in the surfactant group and 8.1 +/- 2.4 days in the control group. Conclusions: Surfactant replacement was well tolerated in patients with lung contusions and severe hypoxemia and resulted in improved oxygenation and compliance.