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Surfactant therapy in infants and children: three years experience in a pediatric intensive care unit
Michael M Hermon1, Johann Golej, Gudrun Burda
1Department of Neonatology and Paediatric Intensive Care, University Children's Hospital, University of Vienna, Austria.
Insights
A single dose of surfactant significantly improves pulmonary function in children with acute respiratory distress syndrome (ARDS). However, a second surfactant dose did not provide additional benefits for these patients.
Area of Science:
- Pediatric critical care medicine
- Pulmonology
- Neonatal and pediatric respiratory support
Background:
- Surfactant therapy is established in neonates but debated in older children.
- Acute Respiratory Distress Syndrome (ARDS) in children can stem from various conditions, including post-cardiac surgery.
- The efficacy of surfactant in pediatric ARDS requires further investigation.
Purpose of the Study:
- To evaluate the impact of surfactant application on pulmonary function in children with ARDS.
- To determine if repeated surfactant treatment offers additional benefits.
- To assess the effect of surfactant on lung injury scores and clinical outcomes.
Main Methods:
- Retrospective chart review of 19 children (over 4 weeks old) with ARDS.
- Measurement of oxygenation index (OI) and hypoxemia score pre- and post-surfactant administration.
- Calculation of lung injury score and analysis of outcomes like survival and ventilation duration.
Main Results:
- Pulmonary function significantly improved 24 hours after the first surfactant application (p=0.027 for OI, p=0.0026 for hypoxemia score).
- A second surfactant application in seven children did not yield further improvements in pulmonary function.
- Lung injury score and overall outcomes (survival, ventilation duration, ICU/hospital stay) were not significantly affected by surfactant therapy.
Conclusions:
- A single surfactant dose is beneficial for improving pulmonary function in pediatric ARDS.
- Repeated surfactant administration does not appear to enhance pulmonary function or clinical outcomes in this population.
- Further research may be needed to optimize surfactant use in specific pediatric ARDS subgroups.
Abstract:
Despite the established success of surfactant application in neonates, the use of surfactant in older children is still a matter of discussion. We hypothesized that surfactant application in children with acute respiratory distress syndrome (ARDS) secondary to a pulmonary or systemic disease or after cardiac surgery improves pulmonary function. We also asked whether repeated treatment could further improve pulmonary function. To answer these questions, we measured oxygenation index (OI) and hypoxemia score after the first and after a second application of surfactant (50-100 mg/kg body wt) at least 24 h later. We enrolled 19 children (older than 4 weeks) for a retrospective chart review study, and six of them underwent cardiac surgery. Demographic data were extracted. OI and hypoxemia score were estimated before and 2 and 24 h after surfactant application. Lung injury score was calculated before and 24 h after surfactant application. Outcome measures included survival, duration of mechanical ventilation, and pediatric ICU and hospital stay. The median patient age was 9.0 (quarter percentile 3.7/25) months. The median weight was 8.4 (4.1/11.5) kg. The median lung injury score before the first surfactant application was 2.3 (2.3/2.6). Hospital duration and pediatric ICU stay for all patients was 31.0 (20.0/49.5) days and 27.0 (15.5/32.5) days, respectively. The duration of mechanical ventilation was 24.0 (18.5/31.0) days. The overall mortality was 53%. Twenty-four hours after the first surfactant application, pulmonary function significantly improved. The median OI was 14 (5.5/26) before and 7 (4.5/14.5) 24 h after surfactant application (P= 0.027). The hypoxemia score was 91.7 (69.9/154.2) before and 148.4 (99.2/167.6) 24 h after surfactant application (P = 0.0026). Seven children received a second application, which did not further improve pulmonary function. The lung injury score was not influenced by either surfactant application. We conclude that a single surfactant application improves pulmonary function in children with ARDS. A second application of surfactant showed no further benefit. Outcome was not affected in our study population.