Bronchoscopic administration of bovine natural surfactant in ARDS and septic shock: impact on gas exchange and haemodynamics

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Abstract
The aim of the present study was to investigate the feasibility and efficacy of bronchoscopic surfactant administration in a noncontrolled multicentre study in five university centres. A total number of 27 patients, suffering from severe acute respiratory distress syndrome (mean±sem lung injury score: 3.15±0.06) and septic shock (Acute Physiology and Chronic Health Evaluation (APACHE) II score at study entry 33.2±1.3, lactate 4.3±0.6 mmol·L−1) were studied. The patients were ventilated with a mean tidal volume of 11.0±0.5 mL·kg−1 body weight (bw), either volume or pressure controlled, with 16.3±2.8 cmH2O positive end-expiratory pressure, for an average of 3.5±0.3 days at study entry. A natural bovine surfactant extract (300 mg·kg−1 bw Alveofact®; mean total volume 378 mL) was delivered in divided doses to each segment of the lungs via flexible bronchoscope within ∼45 min. No untoward effects on gas exchange, lung mechanics and haemodynamics were noted during the procedure of surfactant administration. Within 12 h the oxygen tension in arterial blood/inspiratory oxygen fraction increased from a mean of 109±8 mmHg to 210±20 mmHg (p−1 was administered 18–24 h after the first application, again improving arterial oxygenation. A total of 15 patients survived the 28-day study period (mortality rate 44.4%, compared to a calculated risk of death for the given APACHE II scores of 74.0±3.5%), with all causes of death being nonrespiratory. The bronchoscopic application of a high dose of natural surfactant in patients with severe acute respiratory distress syndrome and septic shock is both feasible and safe, resulting in a pronounced improvement in gas exchange.

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