Surfactant therapy for bronchiolitis in critically ill infants

Area of Science:

• Pediatric Critical Care Medicine
• Neonatology
• Respiratory Physiology

Background:

• Bronchiolitis is a leading cause of respiratory failure in infants, often necessitating intensive care and mechanical ventilation.
• Limited evidence exists for effective treatments beyond supportive care for bronchiolitis.
• Surfactant abnormalities are noted in severe bronchiolitis, suggesting exogenous surfactant as a potential therapy.

Purpose of the Study:

• To assess the efficacy of exogenous surfactant administration in reducing mortality and mechanical ventilation duration in infants and children with bronchiolitis.
• To compare exogenous surfactant versus placebo, no intervention, or standard care.

Main Methods:

• Systematic review and meta-analysis of prospective randomized controlled trials (RCTs) and quasi-RCTs.
• Searched multiple databases including CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS, and Web of Science up to June 2015.
• Included three small RCTs with a total of 79 participants.

Main Results:

• Pooled analysis showed no significant difference in mechanical ventilation duration but a reduced intensive care unit (ICU) stay with surfactant use.
• Excluding one heterogeneous trial, surfactant significantly decreased both mechanical ventilation and ICU stay durations.
• Favorable effects on oxygenation and CO2 elimination were observed, with no reported adverse effects.

Conclusions:

• Exogenous surfactant shows potential benefits for mechanical ventilation duration, ICU stay, oxygenation, and CO2 elimination in bronchiolitis.
• The current evidence base, derived from few and small studies, is insufficient to definitively establish surfactant therapy's effectiveness.
• Larger, adequately powered trials and cost-effectiveness analyses are needed to confirm the role of surfactant therapy in critically ill infants with bronchiolitis.