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. 1999 Mar;80(3):248–252. doi: 10.1136/adc.80.3.248

Surfactant treatment for acute respiratory distress syndrome

J Lopez-Herce 1, N de Lucas 1, A Carrillo 1, A Bustinza 1, R Moral 1
PMCID: PMC1717873  PMID: 10325705

Abstract

OBJECTIVE—To determine prospectively the efficacy 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 (PaO2/FiO2 < 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 effective when the PaO2/FiO2 improved by > 20%.
RESULTS—After initial surfactant administration the PaO2/FiO2 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 PaO2/FiO2 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.



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Selected References

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  1. Anzueto A., Baughman R. P., Guntupalli K. K., Weg J. G., Wiedemann H. P., Raventós A. A., Lemaire F., Long W., Zaccardelli D. S., Pattishall E. N. Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N Engl J Med. 1996 May 30;334(22):1417–1421. doi: 10.1056/NEJM199605303342201. [DOI] [PubMed] [Google Scholar]
  2. Arnold J. H., Hanson J. H., Toro-Figuero L. O., Gutiérrez J., Berens R. J., Anglin D. L. Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med. 1994 Oct;22(10):1530–1539. [PubMed] [Google Scholar]
  3. Bernard G. R., Artigas A., Brigham K. L., Carlet J., Falke K., Hudson L., Lamy M., LeGall J. R., Morris A., Spragg R. Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med. 1994;20(3):225–232. doi: 10.1007/BF01704707. [DOI] [PubMed] [Google Scholar]
  4. Cummings J. J., Holm B. A., Hudak M. L., Hudak B. B., Ferguson W. H., Egan E. A. A controlled clinical comparison of four different surfactant preparations in surfactant-deficient preterm lambs. Am Rev Respir Dis. 1992 May;145(5):999–1004. doi: 10.1164/ajrccm/145.5.999. [DOI] [PubMed] [Google Scholar]
  5. Davis S. L., Furman D. P., Costarino A. T., Jr Adult respiratory distress syndrome in children: associated disease, clinical course, and predictors of death. J Pediatr. 1993 Jul;123(1):35–45. doi: 10.1016/s0022-3476(05)81534-3. [DOI] [PubMed] [Google Scholar]
  6. DeBruin W., Notterman D. A., Magid M., Godwin T., Johnston S. Acute hypoxemic respiratory failure in infants and children: clinical and pathologic characteristics. Crit Care Med. 1992 Sep;20(9):1223–1234. doi: 10.1097/00003246-199209000-00008. [DOI] [PubMed] [Google Scholar]
  7. Evans D. A., Wilmott R. W., Whitsett J. A. Surfactant replacement therapy for adult respiratory distress syndrome in children. Pediatr Pulmonol. 1996 May;21(5):328–336. doi: 10.1002/(SICI)1099-0496(199605)21:5<328::AID-PPUL9>3.0.CO;2-I. [DOI] [PubMed] [Google Scholar]
  8. Gregory G. A., Phibbs R. H. Surfactant replacement for respiratory failure: lessons from the neonate. Anesth Analg. 1993 Mar;76(3):465–466. doi: 10.1213/00000539-199303000-00001. [DOI] [PubMed] [Google Scholar]
  9. Gregory T. J., Longmore W. J., Moxley M. A., Whitsett J. A., Reed C. R., Fowler A. A., 3rd, Hudson L. D., Maunder R. J., Crim C., Hyers T. M. Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome. J Clin Invest. 1991 Dec;88(6):1976–1981. doi: 10.1172/JCI115523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Haslam P. L., Hughes D. A., MacNaughton P. D., Baker C. S., Evans T. W. Surfactant replacement therapy in late-stage adult respiratory distress syndrome. Lancet. 1994 Apr 23;343(8904):1009–1011. doi: 10.1016/s0140-6736(94)90128-7. [DOI] [PubMed] [Google Scholar]
  11. Hickling K. G., Walsh J., Henderson S., Jackson R. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med. 1994 Oct;22(10):1568–1578. doi: 10.1097/00003246-199422100-00011. [DOI] [PubMed] [Google Scholar]
  12. LeVine A. M., Lotze A., Stanley S., Stroud C., O'Donnell R., Whitsett J., Pollack M. M. Surfactant content in children with inflammatory lung disease. Crit Care Med. 1996 Jun;24(6):1062–1067. doi: 10.1097/00003246-199606000-00029. [DOI] [PubMed] [Google Scholar]
  13. Lewis J. F., Jobe A. H. Surfactant and the adult respiratory distress syndrome. Am Rev Respir Dis. 1993 Jan;147(1):218–233. doi: 10.1164/ajrccm/147.1.218. [DOI] [PubMed] [Google Scholar]
  14. Lewis J. F., Veldhuizen R. A. Factors influencing efficacy of exogenous surfactant in acute lung injury. Biol Neonate. 1995;67 (Suppl 1):48–60. doi: 10.1159/000244206. [DOI] [PubMed] [Google Scholar]
  15. López-Herce Cid J., Cueto Calvo E., Carrillo Alvarez A., Vázquez García P., Bustinza Arriortúa A., Moral Torrero R. Respuesta aguda a la administración de óxido nítrico en niños. An Esp Pediatr. 1997 Jun;46(6):581–586. [PubMed] [Google Scholar]
  16. Macnaughton P. D., Evans T. W. The effect of exogenous surfactant therapy on lung function following cardiopulmonary bypass. Chest. 1994 Feb;105(2):421–425. doi: 10.1378/chest.105.2.421. [DOI] [PubMed] [Google Scholar]
  17. McGowan F. X., Jr, Ikegami M., del Nido P. J., Motoyama E. K., Kurland G., Davis P. J., Siewers R. D. Cardiopulmonary bypass significantly reduces surfactant activity in children. J Thorac Cardiovasc Surg. 1993 Dec;106(6):968–977. [PubMed] [Google Scholar]
  18. Moler F. W., Custer J. R., Bartlett R. H., Palmisano J. M., Akingbola O., Taylor R. P., Maxvold N. J. Extracorporeal life support for severe pediatric respiratory failure: an updated experience 1991-1993. J Pediatr. 1994 Jun;124(6):875–880. doi: 10.1016/s0022-3476(05)83174-9. [DOI] [PubMed] [Google Scholar]
  19. Moreno M., Lopez-Herce J., Merello C., Alcaraz A., Carrillo A. Exogenous surfactant therapy for acute respiratory distress in infancy. Intensive Care Med. 1996 Jan;22(1):87–87. doi: 10.1007/BF01728337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Morris A. H., Wallace C. J., Menlove R. L., Clemmer T. P., Orme J. F., Jr, Weaver L. K., Dean N. C., Thomas F., East T. D., Pace N. L. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):295–305. doi: 10.1164/ajrccm.149.2.8306022. [DOI] [PubMed] [Google Scholar]
  21. Murdoch I. A., Storman M. O. Improved arterial oxygenation in children with the adult respiratory distress syndrome: the prone position. Acta Paediatr. 1994 Oct;83(10):1043–1046. doi: 10.1111/j.1651-2227.1994.tb12981.x. [DOI] [PubMed] [Google Scholar]
  22. Rossaint R., Falke K. J., López F., Slama K., Pison U., Zapol W. M. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med. 1993 Feb 11;328(6):399–405. doi: 10.1056/NEJM199302113280605. [DOI] [PubMed] [Google Scholar]
  23. Willson D. F., Jiao J. H., Bauman L. A., Zaritsky A., Craft H., Dockery K., Conrad D., Dalton H. Calf's lung surfactant extract in acute hypoxemic respiratory failure in children. Crit Care Med. 1996 Aug;24(8):1316–1322. doi: 10.1097/00003246-199608000-00008. [DOI] [PubMed] [Google Scholar]
  24. do Campo J. L., Bertranou E. G., De Lorenzi A., Hager A. A. Nebulised exogenous natural surfactant after cardiac surgery. Lancet. 1994 Feb 19;343(8895):482–482. doi: 10.1016/s0140-6736(94)92727-8. [DOI] [PubMed] [Google Scholar]
  25. van der Bleek J., Plötz F. B., van Overbeek F. M., Heikamp A., Beekhuis H., Wildevuur R. H., Okken A., Bambang Oetomo S. Distribution of exogenous surfactant in rabbits with severe respiratory failure: the effect of volume. Pediatr Res. 1993 Aug;34(2):154–158. doi: 10.1203/00006450-199308000-00009. [DOI] [PubMed] [Google Scholar]

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