Surfactant Replacement

Abstract

The phase 3 studies on the effect of recombinant surfactant protein C in the acute respiratory distress syndrome, reported by Spragg et al. (Aug. 26 issue),¹ address an important question. I would be interested in an explanation (biologic or otherwise) for the observed improvement in oxygenation in the first 24 hours in the group receiving active treatment, as compared with the control group, but an observed (albeit nonstatistical) trend toward a reduction in ventilator-free days (3.5 vs. 6 days) and a lower survival rate at 28 days (68 vs. 75 percent) in the North American Study. Could improved oxygenation early on facilitate greater free-radical formation (in the context of high concentrations of inspired oxygen) and promote further injury?