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Calf's lung surfactant extract in acute hypoxemic respiratory failure in children
D F Willson1, J H Jiao, L A Bauman
1Department of Pediatrics, Children's Medical Center, University of Virginia, Charlottesville, USA.
Insights
Calf lung surfactant improved oxygenation and reduced ventilator support in children with respiratory failure. This open-label trial suggests safety and efficacy, warranting further controlled studies.
Area of Science:
- Neonatal and Pediatric Respiratory Medicine
- Pulmonary Surfactant Therapy
- Critical Care Medicine
Background:
- Acute hypoxemic respiratory failure (AHRF) in children presents with diffuse pulmonary infiltrates and requires mechanical ventilation.
- Current treatment options for pediatric AHRF have significant limitations and associated mortality.
- Exogenous surfactant administration has shown promise in neonatal respiratory distress syndrome.
Purpose of the Study:
- To evaluate the safety and short-term efficacy of calf lung surfactant in pediatric patients with acute hypoxemic respiratory failure.
- To assess the impact of surfactant therapy on oxygenation and ventilator support in this population.
- To identify potential complications associated with calf lung surfactant administration.
Main Methods:
- An open-label, multi-institutional, uncontrolled, observational trial was conducted in six pediatric intensive care units.
- Twenty-nine children with AHRF requiring mechanical ventilation and an oxygenation index >= 7 were enrolled.
- Patients received up to four doses of intratracheal calf lung surfactant (80 mL/m2).
Main Results:
- Twenty-four out of 29 patients demonstrated immediate improvement in oxygenation and reduced ventilator support post-surfactant administration.
- Subsequent doses of surfactant showed a modest but not statistically significant effect.
- Three patients experienced air leaks, with two cases coinciding with surfactant administration. The overall mortality rate was 14%.
Conclusions:
- Calf lung surfactant administration appears safe and effective for improving oxygenation and moderating ventilator support in pediatric AHRF.
- The observed improvements suggest that exogenous surfactant is a viable therapeutic option for this condition.
- These findings support the need for a randomized, controlled study to further validate the efficacy of calf lung surfactant.
Objective:
Open-label trial of the safety and short-term efficacy of calf's lung surfactant in pediatric respiratory failure.
Design:
Multi-institutional, uncontrolled, observational trial.
Setting:
Six pediatric intensive care units of tertiary medical centers.
Patients:
Twenty-nine children with acute hypoxemic respiratory failure, characterized by diffuse, bilateral, pulmonary infiltrates, need for ventilator support, and an oxygenation index of > or = 7.
Interventions:
Up to four doses of intratracheal surfactant (80 mL/m2).
Measurements And Main Results:
Ventilator parameters, arterial blood gases, and derived oxygenation and ventilation indices were recorded before, and at intervals after, surfactant administration. Complications and outcome measures were also noted. There was immediate improvement in oxygenation and moderation of ventilator support associated with surfactant administration in 24 of 29 patients. A modest but statistically insignificant effect was seen with subsequent doses. The only complications occurred in three patients who developed airleaks, two of which were coincident with surfactant administration. The overall mortality rate was 14%, which compares favorably with other published series.
Conclusions:
Administration of calf's lung surfactant appears to be safe and is associated with rapid improvement in oxygenation and moderation of ventilator support in children with acute hypoxemic respiratory failure. These results set the stage for a randomized, controlled study.