Surfactant Therapy for the Treatment of Acute Respiratory Distress Syndrome: Time to Revisit?

Pulmonary surfactant is a vital component of respiratory physiology. Surfactant homeostasis is disrupted in various pulmonary disease states, and exogenous surfactant therapy has been proposed as a treatment to improve lung function and recovery. Although this therapy has demonstrated clinically significant benefits in neonatal respiratory distress syndrome, for adult patients with acute respiratory distress syndrome (ARDS), the evidence is inconclusive. To understand the potential shortcomings of past trials and potential opportunities for more effective exogenous surfactant use in ARDS, we review in detail past trials and literature involving exogenous surfactant therapy in adult patients with ARDS. We then assess various factors that may have impacted trial results and propose various solutions and areas of future research. We believe that both past and recent advances in surfactant research have the potential to inform high-quality research that can properly evaluate the potential efficacy of exogenous surfactant therapy for adult patients with ARDS.