ABSTRACT
This chapter examines exogenous surfactant therapy and its utility in miti-
gating clinical acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Extensive biophysical research indicates that inhibi-
tor-induced surfactant dysfunction in lung injury can be reversed or miti-
gated by increasing surfactant concentration (Chapter 9). In addition,
research in animal models of ALI=ARDS indicates that surfactant dysfunction in injured lungs in vivo can be improved by exogenous surfactant
administration. Exogenous surfactant therapy is now standard in neonatal
intensive care, and is life-saving in preventing or treating the respiratory dis-
tress syndrome (RDS) in premature infants. However, extension of this therapy to patients with clinical ALI=ARDS is still under investigation. This chapter details the rationale and current status of exogenous surfactant
therapy in infants, children, and adults with ALI=ARDS. Also emphasized are factors that complicate surfactant therapy in ALI=ARDS, including the multifaceted pathophysiology of inflammatory lung injury, the
heterogeneity of affected patient populations, and the difficulty of delivering
exogenous surfactant material to alveoli in injured lungs. Differences in
activity and inhibition resistance among clinical exogenous surfactants
are also detailed, and examples of on-going exogenous surfactant develop-
ment are described. The possibility of using exogenous surfactant therapy in
combination with agents directed against other aspects of inflammatory lung injury is also noted (combined-modality interventions for lung injury
are described in detail in Chapter 19).
