A shared protocol for porcine surfactant use in pediatric acute respiratory distress syndrome: a feasibility study

Abstract

Background Pediatric ARDS still represents a difficult challenge in Pediatric Intensive Care Units (PICU). Among different treatments proposed, exogenous surfactant showed conflicting results. Aim of this multicenter retrospective observational study was to evaluate whether poractant alfa use in pediatric ARDS might improve gas exchange in children less than 2 years old, according to a shared protocol. Methods The study was carried out in fourteen Italian PICUs after dissemination of a standardized protocol for surfactant administration within the Italian PICU network. The protocol provides the administration of surfactant (50 mg/kg) divided in two doses: the first dose is used as a bronchoalveolar lavage while the second as supplementation. Blood gas exchange variations before and after surfactant use were recorded. Results Sixty-nine children, age 0–24 months, affected by Acute Respiratory Distress Syndrome treated with exogenous porcine surfactant were enrolled. Data collection consisted of patient demographics, respiratory variables and arterial blood gas analysis. The most frequent reasons for PICU admission were acute respiratory failure, mainly bronchiolitis and pneumonia, and septic shock. Fifty-four children (78.3%) had severe ARDS (define by oxygen arterial pressure and inspired oxygen fraction ratio (P/F) < 100 ), 15 (21.7%) had moderate ARDS (100 < P/F < 200). PO 2 , P/F, Oxygenation Index (OI) and pH showed a significant improvement after surfactant use with respect to baseline ( p < 0.001 at each included time-point for each parameter). No significant difference in blood gas variations were observed among four different subgroups of diseases (bronchiolitis, pneumonia, septic shock and others). Overall, 11 children died (15.9%) and among these, 10 (90.9%) had complex chronic conditions. Two children (18.2%) died while being treated with Extracorporeal Membrane Oxygenation (ECMO). Mortality for severe pARDS was 20.4%. Conclusion The use of porcine Surfactant improves oxygenation, P/F ratio, OI and pH in a population of children with moderate or severe pARDS caused by multiple diseases. A shared protocol seems to be a good option to obtain the same criteria of enrollment among different PICUs and define a unique way of use and administration of the drug for future studies.

The Use of Exogenous Lung Surfactant (Poractant Alfa) in Acute Respiratory Failure by Drowning

“…An Italian multicenter study showed improvements in oxygenation, PaO2/FiO2 ratio, oxygenation index, and pH in a population of children with moderate or severe ARDS caused by multiple diseases [17]. Another multicenter study conducted in Cuba on children with ARDS showed improvements in respiratory parameters and survival [18].…”

Surfactant therapies for pediatric and neonatal ARDS: ESPNIC expert consensus opinion for future research steps

“…Surfactant trials published so far have also quite different key features, and this made data aggregation difficult, especially for pediatric patients. Only recently, a multicenter study led to definition of sharing criteria to administer surfactant in PARDS as compassionate therapy [ 98 ]. Currently ongoing explanatory trials recruit homogeneous populations of infants with bronchiolitis-induced PARDS [ 60 , 99 ].…”

Budget impact analysis of surfactant therapy for bronchiolitis in critically ill infants: the Colombian National Health System perspective

“…Surfactant is the therapy with the highest level of expectations due to a positive effect in PICU length of stay, but still a few evidence in endpoints such as mortality. A recent study shows that the use of porcine Surfactant improves oxygenation, P/F ratio, and pH in a population of children with moderate or severe pediatric acute respiratory distress syndrome caused by multiple diseases [ 18 ]. In an infant with severe RSV infection, the administration in mechanically ventilated infants with acute respiratory failure due to RSV bronchiolitis improves gas exchange and respiratory and shortens the duration of mechanical ventilation and PICU stay compared with control [ 6 ].…”