Abstract
In a recent meta-analysis, surfactant administration in paediatric acute respiratory failure was associated with improved oxygenation, reduced mortality, increased ventilator-free days and reduced duration of ventilation. Surfactant is expensive, however, and its use involves installation of large volumes into the lungs, resulting in transient hypoxia and hypotension in some patients. Many questions also remain unanswered, such the as optimum dosage and the timing of administration of surfactant. The merits of surfactant administration should therefore still be decided on an individual case-by-case basis.
Highlights
Duffett and colleagues performed a meta-analysis of the six published randomised trials of surfactant therapy in intubated and ventilated children with acute respiratory failure [1]
The meta-analysis provides strong evidence for the use of surfactant in acute respiratory failure in children, but where should it fit in our treatment algorithm?
If the above therapies do not work, we are faced with a number of options, including surfactant, high-frequency oscillatory ventilation, steroids, and inhaled nitric oxide
Summary
Duffett and colleagues performed a meta-analysis of the six published randomised trials of surfactant therapy in intubated and ventilated children with acute respiratory failure [1]. In all six trials, involving a total of 314 patients, surfactant administration was associated with beneficial effects, including improved oxygenation, reduced mortality, increased ventilator-free days and reduced duration of ventilation. The meta-analysis provides strong evidence for the use of surfactant in acute respiratory failure in children, but where should it fit in our treatment algorithm?
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