RT Book, Section
A1 Lewis, James F.
A1 Puntorieri, Valeria
A2 Tobin, Martin J.
SR Print(0)
ID 57080335
T1 Chapter 60. Surfactant
T2 Principles and Practice of Mechanical Ventilation, 3e
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-173626-8
LK accessanesthesiology.mhmedical.com/content.aspx?aid=57080335
RD 2024/10/14
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.