"Treatment of total atelectasis of the left lung in severe ARDS with side-separated ventilation and surfactant administration"

Severe thoracic trauma is always an important risk factor for the development of acute pulmonary failure. The course is often complicated by barotrauma or volutrauma. We report on a 48-year-old patient who was transferred to us nine days after a bicycle accident because of a severe disturbance of gas exchange and atelectasis of the left lung refractory to therapy. The left lung could not be ventilated even after separate artificial ventilation on each side with positive end expiratory pressure. After administration of surfactant (50 mg Exosurf per kg body weight) and continued separate artificial ventilation on each side, there was a complete re-expansion of the left lung with an increase of the arterial pO2 value from 65 mm Hg to 416 mm Hg with a FIO2 of 1,0 and a decrease of the intrapulmonary venous admixture from 34% to 12% within a few hours. The extravascular pulmonary fluid was unaffected by the administration of surfactant (200 ml solution). The administration of surfactant preparations may be a new therapeutic approach in treatment of ARDS patients.