High-permeability edema of the lung, once called albuminous expectoration, was described over a century ago by Pinault, occurring in a setting we would now identify as re-expansion pulmonary edema.<sup>43 Riesman R. Albuminous expectoration following thoracocentesis Am J Med Sci 1902 ;  123 : 620-630

Cliccare qui per andare alla sezione Riferimenti</sup> Ashbaugh et al<sup>3 Ashbaugh D.G., Bigelow D.B., Petty T.L. , e al. Acute respiratory distress in adults Lancet 1967 ;  2 : 319-323  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> provided the first medical description of such edema occurring in association with trauma, pancreatitis, drug ingestion, aspiration, or lung infection. These investigators, studying fluid from the minced lungs of two patients, noted that it reduced surface tension on a Wilhelmy balance to 24 and 21 dynes/cm²—more than twice the value they considered normal. These early observations, made at a time when the surfactant system of the lung was largely a theoretical consideration, prompted the conclusion that surfactant “loss is associated with the development of the clinical, physiologic, and pathological conditions” in patients with acute respiratory distress syndrome (ARDS).

Since these prescient observations, critical components of lung surfactant have been identified, and alterations in the levels of those components in the setting of the acute respiratory ARDS have been described. Animal models of ARDS have been developed that reflect the alterations seen in human disease, and results of treatment with exogenous surfactant suggest benefit derived from that intervention. Infants with respiratory distress syndrome have been shown to share certain pathologic features with ARDS patients and to benefit from surfactant therapy. Finally, limited clinical experience suggests that patients with ARDS may benefit from treatment with exogenous surfactant. This article presents considerations pertinent to surfactant treatment of patients with ARDS and reviews current relevant investigations.