Consensus on surfactant and inhaled nitric oxide for ARDS.

Adult respiratory distress syndrome (ARDS) remains a major problem in intensive care medicine. While the triggers are not well understood, the process often involves generalized neutrophil activation and sequestration in the lung which initiate inflammatory cascades. These effects can be localized to the pulmonary tissues as well as diffusely throughout the body. Should the latter occur, the patient presents with multiple organ failure (MOF). Attempts to interfere with this series of events have included replacement therapy for surfactant and its components because of observations that the natural surfactant mechanisms are impaired or damaged. The effectiveness of replacement therapy has been tested in various protocols involving synthetic composites and animal (bovine) surfactants. While major differences in protocol design have led to conflicting results, there appears to be evidence that installation of bovine surfactant can reduce mortality in ARDS. A major limitation in adult therapeutics utilizing surfactant is the method of delivery; direct instillation utilizes large quantities, thus limiting its availability. Aerosolized therapy may have promise if smaller amounts delivered by this modality are more effective. Inhaled nitric oxide may also have therapeutic potential in ARDS. By improving ventilation perfusion mismatch, ventilatory requirements can be reduced.