The use of surfactant in children with acute respiratory distress syndrome: efficacy in terms of oxygenation, ventilation and mortality

Abstract

Purpose. The aim of this prospectively designed study was to investigate the efficacy of surfactant (S) for acute respiratory distress syndrome (ARDS) in children. Materials and methods. Children with ARDS were included in this study. Surfactant (Survanta, Abbott, USA) was given intratracheally at a dose of 150 mg/kg every 12 h for a total of two doses. During the study period none of the patients received permissive hypercapnia, high frequency ventilation, nitric oxide or ECMO. Peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), ventilation rate, mean airway pressure, tidal volume (TV), Murray index, PaO 2/FiO 2, ventilation index (VI), oxygen index (OI) and arterial oxygen tension difference (A-aDO 2) were measured before and 48 h after surfactant treatment. Duration of mechanical ventilation therapy, duration in paediatric intensive care unit (PICU) and mortality rate were recorded. Results. Among the 36 children who met the inclusion criteria, 12 were treated with surfactant. The mean age was 72.5±56.2 months; 47% of children were male. Infants were ventilated by pressure-controlled ventilators whereas for older children volume-controlled ventilators were used. Sepsis (42%) was the main predisposing factor followed by pneumonia (25%) and malignancy (17%). The baseline characteristics including age, predisposing factors, gender, PIP, PEEP, A-aDO 2, PaO 2/FiO 2, OI, TV, VI and Murray index were similar in the surfactant and non-surfactant (NS) group ( p>0.05). There were significant improvements in PIP, PEEP, A-aDO 2, PaO 2/FiO 2, OI, TV, VI and Murray index in the surfactant group after surfactant treatment compared with NS group ( p<0.05). Duration of PICU stay and ventilator treatment was longer in NS group (14±3.7, 1.8±3.2 days vs. 9.2±3.1, 8.6±1.9 days), ( p<0.05). Mortality rate was 42% in surfactant compared with 63% in the NS group, ( p>0.05). Children in the surfactant group lived significantly longer ( p<0.05). Conclusions. Modified natural surfactant is an effective treatment option in children with ARDS for improving gas exchange, decreasing the use of ventilatory support and increasing survival time.