This review summarizes the current knowledge on the physiological action of endogenous and exogenous pulmonary surfactant, the role of different types of animal-derived and synthetic surfactants for RDS therapy, different modes of administration, potential risks and strategies of ventilation, and highlights the most promising aims for future development. Scientists have clarified the physicochemical properties and functions of the different components of surfactant, and part of this successful research is derived from the characterization of genetic diseases affecting surfactant composition or function. Knowledge from functional tests of surfactant action, its immunochemistry, kinetics and homeostasis are important also for improving therapy with animal-derived surfactant preparations and for the development of modified surfactants. In the past decade newly designed artificial surfactants and additives have gained much attention and have proven different advantages, but their particular role still has to be defined. For clinical practice, alternative administration techniques as well as postsurfactant ventilation modes, taking into account alterations in lung mechanics after surfactant placement, may be important in optimizing the potential of this most important drug in neonatology.

中文翻译：

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表面活性剂替代疗法：从生物学基础到当前的临床实践

本综述总结了目前关于内源性和外源性肺表面活性剂的生理作用、不同类型的动物源性和合成性表面活性剂在 RDS 治疗中的作用、不同给药方式、潜在风险和通气策略的知识，并强调了最有希望的以未来发展为目标。科学家们已经阐明了表面活性剂不同成分的理化性质和功能，这项成功研究的一部分来自于影响表面活性剂成分或功能的遗传疾病的表征。表面活性剂作用的功能测试、免疫化学、动力学和体内平衡的知识对于改进动物源性表面活性剂制剂的治疗和开发改性表面活性剂也很重要。在过去十年中，新设计的人工表面活性剂和添加剂受到了广泛关注，并已证明具有不同的优势，但它们的具体作用仍有待确定。对于临床实践，考虑到表面活性剂放置后肺力学的改变，替代给药技术以及表面活性剂后通气模式对于优化这种最重要的新生儿药物的潜力可能很重要。