Intratracheal Surfactant Administration Restores Gas Exchange in Experimental Adult Respiratory Distress Syndrome Associated With Viral Pneumonia

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Abstract
The effect of intratracheal surfactant administration was studied in rats with adult respiratory distress syndrome associated with infection with nebulized Sendai virus. Thirty-six hours after infection, animals (n = 7) showed severely impaired gas exchange and acidosis during artificial ventilation (Pao2 = 152.2 ± 18.7, Paco2 = 65.3 ± 29.2, pH = 7.26 ± 0.11) with a pressure-controlled mode, standard frequency of 35/min, peak airway pressure of 15 cm H2O (15/0), inspiratory/expiratory ratio of 1:2, and F102 = 1. Gas exchange improved (P =0.02) with increased ventilator pressures with PEEP (25/4). Forty-eight hours after infection, blood gas tensions could no longer be significantly improved by these same ventilator settings (Pao2 = 123.8 ± 31.0, Paco2 =95.2 ± 43.6, pH7.22 ± 0.26, n = 9). At this time, surfactant replacement dramatically increased arterial oxygenation within 5 min (Pao2 = 389.4 ± 79.9) and resulted in a fourfold increase in Pao2 within 2 h. It is concluded that intratracheal surfactant administration is a promising approach in the treatment of respiratory failure during adult respiratory distress syndrome associated with viral pneumonia.
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