Abstract
Surfactant is synthesized by alveolar type II cells, stored in the lamellar bodies, and secreted to the alveolar space where it covers the epithelial surface [1]. Surfactant consists of phospholipids (85%), different proteins, lipids, and carbohydrates [2]. Surfactant proteins (SP)-B and SP-C are small, extremely hydrophobic proteins that are important in surfactant dynamics within the terminal air spaces and are an essential part in the reduction of surface tension [3]. The composition of surfactant changes in various disease states [4], which leads to alveolar instability, alveolar flooding and alveolar collapse. Initially, surfactant abnormalities were found in infant respiratory distress syndrome (IRDS); later on, changes in the surfactant system were also demonstrated in acute respiratory distress syndrome (ARDS) [5, 6]. Both qualitative and quantitative changes of surfactant have been described in patients with established ARDS [6–8], and in patients at risk for ARDS [8].
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References
King RJ, Clements JA (1972) Surface active materials from dog lung. II. Composition and physiological correlations. Am J Physiol 223: 715–726
Jobe A, Ikegami M (1987) Surfactant for the treatment of respiratory distress syndrome. Am Rev Respir Dis 136: 1256–1275
Frerking I, Gunther A, Seeger W, Pison U (2001) Pulmonary surfactant: functions, abnormalities and therapeutic options. Intensive Care Med 27: 1699–1717
Hallman M, Spragg R, Harrell JH, Moser KM, Gluck L (1982) Evidence of lung surfactant abnormality in respiratory failure. Study of bronchoalveolar lavage phospholipids, surface activity, phospholipase activity, and plasma myoinositol. J Clin Invest 70: 673–683
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2: 319–323
Lewis JF, Jobe AH (1993) Surfactant and the adult respiratory distress syndrome. Am Rev Respir Dis 147: 218–233
Petty TL, Silvers GW, Paul GW, Stanford RE (1979) Abnormalities in lung elastic properties and surfactant function in adult respiratory distress syndrome. Chest 75: 571–574
Gregory TJ, Longmore WJ, Morley MA, et al (1991) Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome. J Clin Invest 88: 1976–1981
Fujiwara T, Maeta H, Chida S, et al (1980) Artificial surfactant therapy in hyaline-membrane disease. Lancet 1: 55–59
Morley CJ (1997) Systematic review of prophylactic vs rescue surfactant. Arch Dis Child Fetal Neonatal Ed 77: F70–74
Jobe AH (2000) Which surfactant for treatment of respiratory distress syndrome. Lancet 355: 1380–1381
Jobe AH, Ikegami M (2000) Lung development and function in preterm infants in the surfactant treatment era. Annu Rev Physiol 62: 825–846
Lachmann B (1989) Animal models and clinical pilot studies of surfactant replacement in adult respiratory distress syndrome. Eur Respir J Suppl 3: 98s - 103s
Weg JG, Balk RA, Tharratt RS, et al (1994) Safety and potential efficacy of an aerosolized surfactant in human sepsis-induced adult respiratory distress syndrome. JAMA 272: 14331438
Kesecioglu J, Schultz MJ, Lundberg D, Lauven PM, Lachmann B (2001) Treatment of acute lung injury (ALI/ARDS) with surfactant. Am J Respir Crit Care Med 163: A819 (abst)
Walmrath D, De Vaal JB, Bruining HA, et al (2000) Treatment of ARDS with rSP-C surfactant. Am J Respir Crit Care Med 161: A379
Gregory TJ, Steinberg KP, Spragg R, et al (1997) Bovine surfactant therapy for patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 155: 1309–1315
Anzueto A, Baughman RP, Guntupalli KK, et al (1996) Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N Engl J Med 334: 1417–1421
Walmrath D, Grimminger F, Pappert D, et al (2002) Bronchoscopic administration of bovine natural surfactant in ARDS and septic shock: impact on gas exchange and haemodynamics. Eur Respir J 19: 805–810
Gunther A, Schmidt R, Harodt J, et al (2002) Bronchoscopic administration of bovine natural surfactant in ARDS and septic shock: impact on biophysical and biochemical surfactant properties. Eur Respir J 19: 797–804
Spragg RG, Gilliard N, Richman P, et al (1994) Acute effects of a single dose of porcine surfactant on patients with the adult respiratory distress syndrome. Chest 105: 195–202
Walmrath D, Gunther A, Ghofrani HA, et al (1996) Bronchoscopic surfactant administration in patients with severe adult respiratory distress syndrome and sepsis. Am J Respir Crit Care Med 154: 57–62
Lachmann B (1987) The role of pulmonary surfactant in the pathogenesis and therapy of ARDS. In: Vincent J-L (ed) Update in Intensive Care and Emergency Medicine. Springer, Berlin, pp 123–134
Richman PS, Spragg RG, Robertson B, Merritt TA, Curstedt T (1989) The adult respiratory distress syndrome: first trials with surfactant replacement. Eur Respir J Suppl 3: 109s - 111s
Haslam PL, Hughes DA, MacNaughton PD, Baker CS, Evans TW (1994) Surfactant replacement therapy in late-stage adult respiratory distress syndrome. Lancet. 343: 1009–1011
Wiswell TE, Smith RM, Katz LB, et al (1999) Bronchopulmonary segmental lavage with Surfaxin (KL(4)-surfactant) for acute respiratory distress syndrome. Am J Respir Crit Care Med 160: 1188–1195
Gommers D, van’t Veen A, Verbrugge SJC, Lachmann B (1998) Comparison of eight different surfactant preparations on improvement of blood gases in lung-lavaged rats. Appl Cardiopulm Pathophysiol 7: 95–102
Ainsworth SB, Beresford MW, Milligan DW, et al (2000) Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25–29 weeks’ gestation: a randomised trial. Lancet 355: 1387–1392
Lachmann B, Eijking EP, So KL, Gommers D (1994) In vivo evaluation of the inhibitory capacity of human plasma on exogenous surfactant function. Intensive Care Med 20: 6–11
Gilliard N, Richman PM, Merritt TA, Spragg RG (1990) Effect of volume and dose on the pulmonary distribution of exogenous surfactant administered to normal rabbits or to rabbits with oleic acid lung injury. Am Rev Respir Dis 141: 743–747
Eijking EP, Gommers D, So KL, et al (1993) Prevention of respiratory failure after hydrochloric acid aspiration by intratracheal surfactant instillation in rats. Anesth Ana1g 76: 472477
Amato MB, Barbas CS, Medeiros DM, et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 338: 347–354
The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342: 1301–1308
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Schultz, M.J., Kesecioglu, J., Lachmann, B. (2003). Trials on Surfactant Replacement Therapy in Patients with ARDS. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-5548-0_31
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DOI: https://doi.org/10.1007/978-1-4757-5548-0_31
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