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Early administration of intratracheal surfactant (calfactant) after hydrocarbon aspiration

Christopher W Mastropietro1, Kevin Valentine

  • 1Department of Pediatrics, Wayne State University, Detroit, Michigan, MI, USA. cmastrop@med.wayne.edu

Pediatrics
|June 1, 2011
PubMed

Insights

Early exogenous surfactant treatment successfully resolved severe lung injury from hydrocarbon aspiration in a pediatric case. This approach offers a promising therapeutic option for acute respiratory failure due to similar ingestions.

Area of Science:

  • Pulmonology
  • Toxicology
  • Pediatric Critical Care

Background:

  • Hydrocarbon ingestions are common causes of accidental poisoning.
  • Aspiration of hydrocarbons can lead to severe pneumonitis and poor outcomes with supportive care alone.

Observation:

  • A 19-month-old girl aspirated lamp oil, developing acute respiratory distress syndrome requiring mechanical ventilation.
  • Her initial oxygenation index (OI) was 13.2, indicating severe respiratory compromise.

Findings:

  • Intratracheal administration of exogenous surfactant (calfactant) 10 hours post-ingestion improved OI to 4.3.
  • A second dose 19 hours post-ingestion maintained OI below 5, allowing successful weaning from mechanical ventilation.
  • The patient was extubated within 64 hours with no residual lung disease.

Implications:

  • Early exogenous surfactant therapy is a viable and potentially life-saving intervention for hydrocarbon aspiration-induced acute respiratory failure.
  • This case supports the pathophysiologic rationale for surfactant-replacement therapy in hydrocarbon pneumonitis.
  • Consideration of surfactant therapy should be advanced in pediatric cases of severe respiratory distress following hydrocarbon ingestion.

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