APPLYING OF THE EXOGENOUS SURFACTANT IN THE CARDIAC SURGERY CLINICS OF ST. PETERSBURG: FROM THE TECHNOLOGY TO THE EVOLUTION OF THERAPEUTIC STRATEGY

Objective. To summarize the experience of the exogenous surfactant therapy for the treatment of postoperative ARDS in the cardiac surgery clinics in St. Petersburg. Methods. Analysis of 56 cases of exogenous surfactant (Surfactant-BL, «Biosurf», Russia) administration for therapy of postoperative ARDS was performed. All the cases were observed from 1998 to 2012 in the cardiac surgery clinics in St. Petersburg. Results. We have divided fifteen-year interval into three periods. First period: 1998-2001 years. Technology of surfactant therapy was developed. When exogenous surfactant was used for ARDS treatment, mortality dropped to 42.1 %. Second period: 2002-2007 years. The surfactant therapy of ARDS was used within the concept of «protective mechanical ventilation». ARDS mortality was 33,3 % in patients treated with surfactant, in the retrospective control group - 50 %. Third period: 2008-2012. This period was characterized by active introduction of a combination of alveolar recruitment maneuver and surfactant therapy for ARDS treatment. In the cases of combination of alveolar recruitment and surfactant therapy mortality dropped to 23.1 %. Discussion. In our study it was found that the surfactant therapy was not effective only in 16 % patients with ARDS after cardiac surgery procedures. Probably, in the future exogenous surfactant administration will reduce mortality in ARDS up to this boundary of its clinical effectiveness.

Кардиохирургия, ОРДС, сурфактант, дыхательная недостаточность, Cardiac surgery, ARDS, surfactant, respiratory failure

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