Novikov N. Morphogenesis of an acute respiratory distress syndrome and influence upon it of replacement surfactant therapy

Morphogenesis of respiratory part of lungs during first six days of an acute respiratory distress syndrome is marked by alveolointerstitial oedema and destruction of epithelial cells, endotheliocytes, basal membranes and extracellular matrix of air-blood barrier and accompanied by decreasing of surface activity of endogenous surfactant. Fibrosis of respiratory part of lungs start on 7-14th day of an acute respiratory distress syndrome as result of synthesis by ?-SMA+ fibroblasts connective tissue in interstitial spaces and alveoli. If an acute respiratory distress syndrome continue 20 days and more single vimentin+ and ?-SMA+ regenerated epithelial cells in fibrously changed regions of respiratory part of lungs lose immunophenotypic peculiarities. In case of administration of surfactant replacement therapy increase lungs elasticity indexes, blood oxygenation and endogenous surfactant production. Also decrease frequency revealing of hyaline membranes, increase amount of neutrophil infiltration foci and signs of interlobular and interalveoli septums fibrosis at dead patients. In experimental model of acute damage of lungs using of surfactant replacement therapy in 6 hours after beginning of action of trigger factor of direct type and also on second and fifth day level the secondary deficit of surfactant and allow to prevent destruction of basal membranes and interstitial tissue on long distance of air-blood barrier at acute phase.