Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

Abstract

Background: To evaluate the effect of low-dose exogenous surfactant therapy on infants suffering acute respiratory distress syndrome (ARDS) after cardiac surgery. Methods: We conducted a retrospective case-control study of infants diagnosed with moderate-severe ARDS after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-hour of surfactant treatment; and secondary endpoints were the ventilator time and PICU time. Results: 22 infants treated with surfactant were matched with 22 controls. Early low-dose (20mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-hour, the surfactant group was much better compared with the control group at the 24-hour in OI (difference in average change from baseline, -6.7 [95% CI, -9.3 to -4.1]) (P < 0.01) and VI (mean difference, -11.9 [95% CI, -18.1 to -5.7]) (P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6h±27.2 vs 218.4h±28.7, P < 0.01 ; 10.7d±5.1 vs 17.5d±6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis.Conclusions: In infants with moderate-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones.

Analysis of the effectiveness of pulmonary surfactant in the treatment of moderate and severe acute respiratory distress syndrome in infants and toddlers —a multicenter prospective study

“…Pulmonary surfactant is delivered via a thin catheter combined with postural changes, this process may not ensure the equal distribution of PS. It is a sample and available method for drug administration and has been used in some research [3,19] .The effectiveness of this method is supported in our study. We did not nd any pneumothorax, pulmonary hemorrhage, mediastinal emphysema, or other complications that are directly caused by exogenous PS delivery, the safety usage of the PS is similar to other studies [5,15,16] .…”

“…Standard PS dose has not been established and remains exploration. In several published studies, the dose range is 20-175 mg/kg [3,15,19] . The subjects in our research are between 29d to 3ys old, and majority of them weigh between 4-13 kilograms.…”