Pulmonary surfactant in ARDS

In the last decade there has been growing insight into surfactant function and metabolism and on how exogenous surfactant exerts its therapeutic effects on lungs mechanics, gas exchange and host defence. Furthermore the worldwide use of therapeutic surfactants for premature newborns, used in conjunction with prenatal steroids, has markedly reduced the morbidity and mortality from respiratory distress syndrome, disease that occurs in premature newborns as a result of lung immaturity and surfactant deficient state. Indications for surfactant replacement have widened in recent years and promising results have been obtained for adult conditions such as the acute respiratory distress syndrome (ARDS). This review will summarise the basic biophysics, physiology and biochemistry of surfactant components and will describe pathophysiological mechanisms interfering with surfactant function during the course of ARDS. It will also highlight how circumvention of these mechanisms may lead to improved surfactant treatment for ARDS in newborns, children and adults.