Successful surfactant replacement therapy in two infants with ARDS due to chlamydial pneumonia

We report two cases of adult respiratory distress syndrome (ARDS) treated successfully with repeated doses of a bovine natural surfactant (Survanta®). Two former premature infants developed severe respiratory failure as a consequence of a chlamydial pneumonia at the age of 3 or 12 weeks, respectively. As both patients were threatened by hypoxia in spite of mechanical ventilation with maximal pressures using 100% O₂ and as the X-rays were compatible with the diagnosis of ARDS, we decided to perform rescue surfactant treatment. Following surfactant instillation, marked improvement in oxygenation and ventilatory requirements was observed. Within 2 h after surfactant replacement, the PaO₂/FiO₂ ratio increased from 52 to 84 (case 1) and from 35 to 94 (case 2), and the peak inspiratory pressure could be reduced from 47 to 40 cm H₂O and from 35 to 28 cm H₂O, respectively. Both infants received a second surfactant dose about 10 h after the initial treatment and survived without developing chronic lung disease.