TY - CHAP M1 - Book, Section TI - Chapter 60. Surfactant A1 - Lewis, James F. A1 - Puntorieri, Valeria A2 - Tobin, Martin J. Y1 - 2013 N1 - T2 - Principles and Practice of Mechanical Ventilation, 3e AB - Pulmonary surfactant lines the inner layer of the lung and serves to lower surface tension at the air–liquid interface, thereby maintaining alveolar stability. In the absence of surfactant, the work of breathing increases markedly ultimately resulting in respiratory failure secondary to atelectasis, alveolar flooding, and severe hypoxemia. The clinical correlate of surfactant deficiency is the neonatal respiratory distress syndrome (NRDS) in preterm infants, which before the mid-1980s was a devastating and fatal disease. Since the advent of exogenous surfactant replacement therapy, however, newborn mortality from NRDS has decreased approximately 56% from 1987 to 1995.1 The primary surfactant deficiency of NRDS is now a well-characterized condition, and does not appear as complex as the various surfactant changes occurring during acute lung injury (ALI) and/or the acute respiratory distress syndrome (ARDS). Alterations of the endogenous surfactant system in the mature lungs of patients with these disorders are not as well understood, but currently represent an area of intense investigation. This complexity has resulted in inconsistent results of clinical trials evaluating exogenous surfactant administration in this patient population. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=57080335 ER -