Surfactant treatment for acute respiratory distress syndrome

Abstract

Objective-To determine prospectively the eYcacy of surfactant in acute respiratory distress syndrome. Study design-Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO 2 /FiO 2 < 100) (13 with systemic or pulmonary disease and seven with cardiac disease) were treated with one to six doses of 50-200 mg/kg of porcine surfactant administered directly into the trachea. The surfactant was considered to be eVective when the PaO 2 /FiO 2 improved by > 20%. Results-After initial surfactant administration the PaO 2 /FiO 2 increased significantly in patients with systemic or pulmonary disease from 68 to 111, and the oxygenation index (OI) diminished significantly from 36.9 to 27.1. The PaO 2 /FiO 2 and OI did not improve in children with cardiac disease. The improvement of the patients who survived was greater than that of those who died. Conclusions-Surfactant moderately improves oxygenation in some children with severe acute respiratory distress syndrome secondary to pulmonary or systemic disease. (Arch Dis Child 1999;80:248-252) Keywords: surfactant; acute respiratory distress syndrome; lung disease Acute respiratory distress syndrome (ARDS) in children can be secondary to multiple causes acting by diVerent mechanisms, such as: direct endothelial damage, decrease and alteration of surfactant, cellular damage by mediators of inflammation (cytokines, complement, products of coagulation, metabolites of arachidonic acid, proteases, and free radicals), and the activation of platelets and leucocytes. These causes produce an alteration in the alveolar capillary membrane, which results in increased permeability and secondary pulmonary oedema.

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.…”

The Future of Exogenous Surfactant Therapy

“…A number of uncontrolled and controlled studies have documented clinical benefit from exogenous surfactant replacement therapy in term infants, children, and adults with acute respiratory failure (ALI/ARDS) [66][67][68][69]154,[186][187][188][189][190][191][192][193][194][195][196][197][198][199][200] ( Table 2). Of the 19 positive studies listed in Table 2, 9 were controlled trials [67][68][69]154,192,[197][198][199][200] and 10 were uncontrolled treatment trials, in which the risk of selection bias is inherent.…”

Elective bone marrow transplantation in a child with X-linked hyper-IgM syndrome presenting with acute respiratory distress syndrome

“…A dose-related response, more evident with higher doses (200 mg/kg) than with lower ones (50 mg/kg), was reported in 10/13 children with severe ARDS not responding to conventional ventilation. 12 Further studies are needed to demonstrate whether early use of surfactant does improve the prognosis of ARDS, which is still extremely poor, with a case-fatality ratio exceeding 40%. With regard to the choice of a 'permanent' therapy, in our case BMT was an elective procedure, performed when the patient's overall condition was good, with normal results of liver function tests.…”