Table 2.

Possible mechanisms and possible solutions for surfactant failure in paediatric acute respiratory distress syndrome (PARDS)

Possible mechanism	Possible solution
sPLA2 inactivation	Use of surfactant refractory to sPLA2 inactivation
Failure to remove PARDS triggers	Adoption of anti-inflammatory agents, antibiotics, anti-viral therapy
Lack of knowledge of effective dose/lavage ratio	Modification of ratio based on BAL studies
Lack of knowledge of effective dose	Modification of dose
Lack of knowledge of effective procedure	Use of bronchoscope and bronchoalveolar lavage
Composition of surfactant	Use of more effective one
Wrong timing	Start earlier the treatment
Poor ventilated lung areas	Lung recruitment by ventilation, bronchial toilette, prone position