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Surfactant therapy for bronchiolitis in critically ill infants
K Ventre1, M Haroon, C Davison
1Primary Children's Medical Center, Division of Critical Care Medicine, 100 N. Medical Drive, Salt Lake City, Utah 84113, USA. kathleen.ventre@hsc.utah.edu
The Cochrane Database of Systematic Reviews
|July 21, 2006
Summary
Exogenous surfactant may reduce mechanical ventilation and intensive care unit (ICU) stay for infants with viral bronchiolitis. However, current evidence is insufficient to confirm these benefits for surfactant therapy in treating this common childhood respiratory illness.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Neonatology
Background:
- Viral bronchiolitis is a frequent cause of respiratory failure in children, leading to significant intensive care unit (ICU) admissions.
- Current treatment for bronchiolitis relies solely on supportive care, with no established evidence-based therapies.
- Exogenous surfactant is a potential therapeutic agent, as its composition is altered in bronchiolitis and it may influence host immunity.
Purpose of the Study:
- To evaluate the efficacy of exogenous surfactant in treating viral bronchiolitis in mechanically ventilated infants and children.
- To synthesize findings from randomized controlled trials (RCTs) comparing surfactant with placebo or no surfactant.
Main Methods:
- Systematic search of major databases (CENTRAL, MEDLINE, EMBASE) and reference lists.
- Inclusion of RCTs involving mechanically ventilated infants and children diagnosed with viral bronchiolitis.
- Independent data extraction and quality assessment by two authors, with requests for unpublished data.
Main Results:
- Three trials with 79 patients were included; no mortality or adverse effects were reported with surfactant use.
- Surfactant administration showed a trend towards reduced mechanical ventilation duration (2.6 days) and ICU stay (3.3 days).
- In studies with comparable control groups, surfactant use decreased ventilator days (1.21 days) and ICU stay (1.81 days), with short-term improvements in pulmonary mechanics and gas exchange.
Conclusions:
- The available data are insufficient to reliably estimate the effects of exogenous surfactant in mechanically ventilated infants with bronchiolitis.
- Further adequately powered studies are required to determine optimal surfactant preparations, dosages, and administration intervals.
- Future research should also investigate the impact of ventilator strategies on surfactant efficacy in treating bronchiolitis.