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

Abstract

Aim: Pneumonia in childhood may be associated with surfactant dysfunction and severe acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the effects of surfactant treatment on oxygenation in 8 infants (age range: 1 mo to 13 y) with severe respiratory failure owing to viral, bacterial or Pneumocystis Carinii pneumonia. Methods and results: Instillation of a modified porcine surfactant (Curosurf®) improved gas exchange immediately. Median paO2/FiO2 increased from 66 to 140mmHg (8.8–18.7 kPa; p < 0.01) within 1 h of surfactant treatment. Seven of the 8 patients received multiple surfactant doses. Four patients (50%) died 3–62 d after surfactant treatment. However, 6 patients (75%) were immunodeficient, so that the observed mortality rate was mainly due to the underlying disease. Conclusion: Surfactant dysfunction probably plays a role in the pathophysiology of severe paediatric ARDS triggered by pneumonia, as it was found that surfactant instillation rapidly improved gas exchange in the majority of the affected infants in our study. Larger randomized controlled studies are necessary to evaluate the effects of surfactant treatment on morbidity and mortality.

Repeat surfactant therapy for postsurfactant slump

“…16,17 Epithelial cell injury by inflammatory mediators can result in increased permeability of the microvasculature leading to leakage of protein and fluid which can also inactivate surfactant. 13,16,18 Out of the 25 patients in our study that required a repeat course of surfactant therapy seven (28%) had an acute infectious process, three (12%) had pulmonary hemorrhage and 21 had worsening BPD (84%) that led to their surfactant dysfunction. Six (24%) of these patients had more than one cause for their respiratory deterioration.…”

“…18,19 Bissinger et al 10 described three patients with secondary surfactant deficiency or postsurfactant slump that responded to repeat courses of surfactant. At our institution, we found that 20% of ELBW infants diagnosis with RDS at birth received repeat surfactant replacement therapy in the second to sixth week of life to treat postsurfactant slump or respiratory failure associated with presumed secondary surfactant deficiency.…”

Surfactant for Pediatric Acute Lung Injury

“…A significant number of clinical studies have reported benefits following the instillation of exogenous surfactants to term infants, children, or adults with ALI/ARDS or related acute respiratory failure [25,[120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135] (Table 4). However, many of these are small case series or pilot studies, and found only improvements in acute lung function (oxygenation).…”

“…Studies of surfactant therapy in children and adults with ALI/ARDS show positive results in a number of case reports or relatively small pilot trials [120,121,[124][125][126][127][128]. However, particularly in adults, controlled clinical trials have been less successful.…”

Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes

“…60 Neonatal pneumonia Pneumonia in children and newborn infants may be associated with surfactant dysfunction and acute RDS. [61][62][63][64][65][66] There are studies involving a small number of neonates who have been treated with rescue surfactant replacement for sepsis and pneumonia that have shown improved gas exchange compared with no surfactant treatment. 61,63,64,67 -69 Verlato et al 70 used the 'exogenous' tracing approach with an endotracheal administration of 13 C-labeled DPPC to study surfactant kinetics in full term with pneumonia, and in preterms with RDS.…”