Artificial surfactant therapy in hyaline membrane disease started in 1980 (Fujiwara). We used it in 10 children with acute respiratory distress syndrome (ARDS) and in 12 newborns suffering from massive aspiration syndrome (MAS). In ARDS, indication was PEEP > or = 8 cmH2O, PaO2 < or = 9 kPa with FiO2 > or = 0.6. Results were rapid. A steady improvement of PaO2 was obtained in 24 hours, generally after a single administration. Three children needed additional doses. In MAS (n = 12) with PaO2 > or = 70 mmHg for FiO2 > 0.6, improvement was obtained very rapidly. Only one newborn received a second dose of surfactant 12 hours after the first one. In MAS as in ARDS all children survived.