Exogenous Surfactant Replacement in ARDS — One Day, Someday, or Never?

Most therapies that fail to show benefit in well-conducted, randomized, controlled trials are abandoned by both clinical investigators and pharmaceutical companies. Treatment with exogenous surfactant for the acute respiratory distress syndrome (ARDS) appears to enjoy a different status. In this issue of the Journal, Spragg and coworkers (pages 884–892) present the results of two multicenter trials of recombinant surfactant therapy in ARDS, showing no significant difference in mortality between the groups of patients who received surfactant and those who received placebo. This report follows a number of other clinical studies, including a large, negative, multicenter, randomized, controlled trial that was . . .