Spragg 2003

Methods	n = 40, 11 centres Allocation concealment: central randomization Baseline similarity: age, modified APACHE II, sepsis Blinding: caregivers unblinded (no placebo) Cointerventions: daily screening for ability to wean Withdrawals: none Losses to follow‐up: none
Participants	Inclusions: Risk factor for ARDS; AECC definition of ARDS; duration of ARDS not more than 48 hours; PEEP of at least 5 cmH20; at least 48 hours of antimicrobial therapy if pneumonia present Exclusions: Hemodynamic instability; severe hypoxaemia; lung cancer; AIDS
Interventions	Intratracheal synthetic surfactant (Venticute, containing 1 mg recombinant surfactant protein C and 50 mg phospholipids per ml), 1 ml/kg up to 4 doses in 24 hours, or 0.5 mL/kg up to 4 doses in 24 hours, or standard therapy
Outcomes	28 day mortality (all surfactant doses versus control): RR 0.67 (95% CI 0.26 to 1.72) Ventilator‐free days to day 28 [median (interquartile range)]: low dose: 4 (0 to 12); high dose 5 (0 to 18); control: 6 (0 to 15); differences reported to be non significant Adverse events leading to discontinuation of therapy: none Other safety data: treatment: 1/27 patients had an adverse event likely related to treatment (transient hypoxia and supraventricular tachycardia); no difference in incidence of serious adverse events
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A ‐ Adequate