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/cmH₂O 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.