Surfactant improves oxygenation in infants and children with pneumonia and acute respiratory distress syndrome

Herting, Egbert; Möller, O; Schiffmann, J H; Robertson, Bengt

doi:10.1080/080352502320777397

Cited by 23 publications

(12 citation statements)

References 19 publications

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“…The improvement in oxygenation in the surfactant treatment group in our study is consistent with trials conducted in the past in both animal (22-28) and human (15,29-31) models. The mechanism of induced injury and surfactant used were different in the various studies; however, most studies reported an improvement in oxygenation (32).…”

Section: Discussionsupporting

confidence: 91%

Surfactant administration prior to one lung ventilation: Physiological and inflammatory correlates in a piglet model

Bhatia

Shaffer

Hossain

et al. 2011

Pediatric Pulmonology

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Summary Objectives To test the hypothesis that surfactant, when given prophylactically during one lung ventilation, improves physiological stability and reduces inflammation. Methods Prospective controlled animal study. After 30 minutes of mechanical ventilation, surfactant was administered to the left lung of the treatment group. Right lung mechanical ventilation continued for 3 hours, after which the left lung was unblocked. Bilateral mechanical ventilation was continued for 30 minutes thereafter. Physiological parameters and biomarkers of inflammation in plasma, lung tissue homogenates, and bronchoalveolar lavage were measured. Measurements and Main Results Oxygenation improved in the surfactant group, reaching statistical significance at 3 hours of one lung ventilation and again after 30 minutes of bilateral mechanical ventilation following the one lung ventilation. Plasma levels of interleukin-1 β, interleukin-6, and tumor necrosis factor-α showed a trend for reduction. The lung homogenates from the ventilated lungs had significantly lower levels of interleukin-1 β (P < 0.01) and interleukin-6 (P < 0.01). The bronchoalveolar lavage specimen showed an overall reduction in the cytokine levels; interleukin-1 β was significantly lower in the ventilated lungs (P < 0.01). Conclusions Surfactant administration improves oxygenation and decreases inflammation, as evidenced by a decrease in several inflammatory cytokines both in the plasma and lungs of a piglet model of one lung ventilation.

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Section: Discussionsupporting

confidence: 91%

Surfactant administration prior to one lung ventilation: Physiological and inflammatory correlates in a piglet model

Bhatia

Shaffer

Hossain

et al. 2011

Pediatric Pulmonology

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“…The mechanism of action is believed to involve leakage of surfactant inhibitors and/or plasma proteins into the bronchoalveolar space, causing a secondary surfactant deficiency or inactivation. 4,28,29 It has thus been postulated that surfactant replacement could improve clinical respiratory status by improving deranged pulmonary mechanics.…”

Section: Bacterialmentioning

confidence: 99%

The Role of Surfactant Therapy in Nonrespiratory Distress Syndrome Conditions in Neonates

Keiser

Bhandari

2015

Amer J Perinatol

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While treatment of respiratory distress syndrome (RDS) with surfactant in premature neonates is well established, evidence for its use in non-RDS conditions, especially in the term neonate, has been less abundant. The last published review on a PubMed search was in 2001. In this review, we comprehensively and critically evaluated the evidence from the literature regarding the use of surfactant in specific non-RDS disorders in neonates. Surfactant administered as a bolus should be considered in the treatment of meconium aspiration syndrome with progressive respiratory failure. While controversial in congenital diaphragmatic hernia, it should be considered in Group B streptococcal pneumonia. As evidence evolves, we anticipate the broader application and more routine use of surfactant therapy for respiratory failure because of causes other than RDS.

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“…Surfactant administration via an endotracheal tube has been investigated as a treatment option in (small, non-randomized) clinical trials on mechanically ventilated pediatric patients suffering from ARDS [23, 24] showing improved oxygenation as an acute effect. The only controlled trial on surfactant treatment in pediatric ARDS did not show a beneficial effect on the duration of mechanical ventilation [25].…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic Surfactant Administration in Pediatric Patients with Persistent Lobar Atelectasis

Krause¹,

Bismarck²,

Oppermann

et al. 2005

Respiration

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Persistent lobar atelectasis in pediatric patients on mechanical ventilation results in impaired gas exchange and lung mechanics and contributes to a further need for mechanical ventilation. The most common types of atelectasis in children are resorption atelectasis following airway obstruction, and atelectasis due to surfactant deficiency or dysfunction. We aimed to determine whether bronchoscopic suctioning and surfactant application to atelectatic lung segments would result in improved oxygenation, ventilation, chest X-ray scoring, and early extubation. Five children with heterogeneous lung diseases (aged between 7 months and 15 years) were treated with a diluted surfactant preparation (Curosurf^TM) in a concentration of 5–10 mg/ml (total dose 120–240 mg) which was instilled into the affected segments. Outcome parameters were gas exchange, radiographic resolution of atelectasis and extubation. All mechanically ventilated patients could be extubated within 24 h following the intervention. Bronchoscopic surfactant application could be carried out without adverse effects and brought improvements in oxygenation, respiratory rate, and partial or complete resolution of atelectases without recurrence.

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Surfactant improves oxygenation in infants and children with pneumonia and acute respiratory distress syndrome

Cited by 23 publications

References 19 publications

Surfactant administration prior to one lung ventilation: Physiological and inflammatory correlates in a piglet model

Surfactant administration prior to one lung ventilation: Physiological and inflammatory correlates in a piglet model

The Role of Surfactant Therapy in Nonrespiratory Distress Syndrome Conditions in Neonates

Bronchoscopic Surfactant Administration in Pediatric Patients with Persistent Lobar Atelectasis

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