Studies of Surfactant Replacement in Premature Lambs with RDS 257

Overview of Animal Models of ARDSRelated Acute Lung Injury with Surfactant Dysfunction 265

Surfactant Replacement in Animal Models of Acute Lung Injury and ARDS 269

Chapter Summary 279

Clinical Surfactant Replacement Therapy for Neonatal RDS 281

Hyaline Membrane Disease Before Neonatal Intensive Care 282

Impact of Mechanical Ventilation and Intensive Care on HMD in Premature Infants 283

Bronchopulmonary Dysplasia BPD in Premature Infants 284

Initial Unsuccessful Clinical Surfactant Therapy for RDS 285

Basic Research Leading to Successful Surfactant Therapy for RDS 286

Initial Positive Uncontrolled or Nonrandomized Surfactant Replacement Studies in RDS in the Early 1980s 287

Successful Controlled Clinical Studies of Exogenous Surfactant Therapy for RDS 288

Clinical Endpoints in Trials of Lung Surfactant Replacement Therapy for RDS 290

Clinical Trials Comparing Different Exogenous Surfactant Preparations 291

Meta Analyses 294

Prophylaxis versus Treatment Rescue Strategies for Exogenous Surfactant Therapy 295

Followup Analyses of Premature Infants and Surfactant Trials 297

Chapter Summary 298

Surfactant and CombinedModality Therapies for Clinical ARDS and Acute Lung Injury 299

Rationale for Surfactant Therapy in Clinical ARDS 300

Factors Complicating Clinical Assessments of Surfactant Therapy for ARDS 301

Surfactant Therapy in FullTerm Infants with ARDSRelated Respiratory Failure 303

Surfactant Therapy in Adults with ARDS 305

Summary of Current Status of Clinical Surfactant Therapy for ARDS 308

Overview of Multimodal Therapy for Clinical ARDS 309

Inhaled Nitric Oxide INO and Other Vasoactive Agents for Use in ARDS 311

AntiInflammatory Agents and Antioxidants for Use in ARDS 313

Specialized Modes of Ventilation for Treating ARDS 316

Chapter Summary 317

Current and Future 319

Basic Science Comparisons of Activity in Clinical Exogenous Surfactants 325

Synthetic Peptides 333

Glossary of Common Terms and Abbreviations 347

References 355