Am. J. Respir. Crit. Care Med., Volume 160, Number 4, October 1999, 1188-1195

Bronchopulmonary Segmental Lavage with Surfaxin (KL₄-Surfactant) for Acute Respiratory Distress Syndrome

THOMAS E. WISWELL, ROBERT M. SMITH, LAURENCE B. KATZ, LISA MASTROIANNI, DAVIES Y. WONG, DAVID WILLMS, STEPHEN HEARD, MARK WILSON, R. DUNCAN HITE, ANTONIO ANZUETO, SUSAN D. REVAK, and CHARLES G. COCHRANE

Discovery Laboratories, Doylestown, Pennsylvania; Division of Pulmonary and Critical Care Medicine, University of California, San Diego, California; Division of Pulmonology, Sharp Memorial Hospital, San Diego, California; Department of Anesthesiology and the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts; Section on Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Division of Pulmonary Diseases, University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Scripps Research Institute, La Jolla, California

We performed a trial to assess the safety and tolerability of sequential bronchopulmonary segmental lavage with a dilute synthetic surfactant (Surfaxin) in 12 adults with ARDS. Patients received one of three dosing regimens in which aliquots of Surfaxin were administered via a wedged bronchoscope to each of the 19 bronchopulmonary segments. Suctioning was performed 10-30 s after instillation of individual aliquots. Group 1 patients (n = 3) received one 30-ml aliquot of a 2.5-mg/ml concentration of Surfaxin in each segment, followed by a second 30-ml aliquot with a 10-mg/ml concentration. Group 2 patients (n = 4) received two 30-ml aliquots of the 2.5-mg/ml concentration followed by a third lavage with the 10-mg/ml concentration. Group 3 patients (n = 5) received therapy identical to that received by patients in Group 2 and were eligible for repeat dosing 6 to 24 h later. All patients tolerated the procedure. There were no serious adverse experiences ascribed to either the procedure or the surfactant. In the 96 h after treatment initiation, FI_O2 decreased from 0.80 to 0.52 and PEEP decreased from 10.3 to 7.6 cm H₂O. Bronchoscopic "cleansing" of the lungs with dilute Surfaxin may offer a safe and feasible approach to improving outcomes in patients with ARDS. Wiswell TE, Smith RM, Katz LB, Mastroianni L, Wong DY, Willms D, Heard S, Wilson M, Hite RD, Anzueto A, Revak SD, Cochrane CG. Bronchopulmonary segmental lavage with Surfaxin (KL₄-surfactant) for acute respiratory distress syndrome.

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