Biophysical rationale and emerging clinical perspectives of surfactants in thoracic surgery: a translational review

Abstract Background Pulmonary surfactants are essential for alveolar stability and gas exchange. While their clinical use is well established in neonatal care, their potential in thoracic surgery remains underexplored. Objective To review the current and emerging applications of surfactants in thoracic surgical practice, and to assess their role in perioperative lung protection. Methods We reviewed recent literature on surfactant biology, perioperative administration strategies, and novel formulations, including bio-derived and responsive surfactants. Results Exogenous surfactants may improve lung compliance, preventing atelectasis, and mitigating postoperative respiratory complications. In thoracic surgery, surfactants may also serve as drug delivery vehicles or anti-inflammatory agents. However, clinical use remains limited, and further studies are needed to define optimal dosing, timing, and patient selection. Conclusions Surfactants represent a versatile and evolving tool in thoracic surgery. With continued innovation and clinical validation, they may become an effective adjunct for enhancing perioperative respiratory outcomes.