Mortality due to ARDS of all etiologies is at least 50%. However, mortality due to ARDS induced by pulmonary aspiration of gastric contents is reportedly greater than 90%. We report the cases of 3 children who aspirated gastric contents and who were subsequently treated with intratracheal surfactant in the hope of reversing the pulmonary dysfunction-hypoxemia and low compliance-associated with their ARDS. All 3 patients demonstrated improvement in oxygenation and compliance after the first dose of surfactant and 2 survived without apparent pulmonary morbidity; 1 patient did not survive but did show transient improvement. Well-controlled clinical trials are needed to expose the therapeutic benefit of surfactant therapy in ARDS from aspiration of gastric contents.
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