title: Adult respiratory distress syndrome and artificial surfactant replacement in the pediatric patient.
abstract: Adult respiratory distress syndrome (ARDS) frequently develops after near-drowning, smoke inhalation, burns, blunt trauma to chest, and overwhelming sepsis. Surfactant depletion, inactivation or destruction by the accumulation of proteinaceous material in the alveoli, and changes in the relative composition of phospholipids or protein component have been associated with ARDS. Artificial surfactant reverses these changes in experimental animals. Seven cases of ARDS have been treated on an experimental basis with artificial surfactant after approval and in accordance with ethical standards of the institution's committee on human experimentation. Informed consent was obtained from parents prior to administering artificial surfactant. We identified five cases of ARDS in retrospective analysis and used them as historical controls. Mortality between these two groups was analyzed with Fisher's exact test. One of seven (14.2%) children treated with surfactant died of overwhelming infection, and 2/5 (40%) of the historical controls died of pulmonary causes (P = 0.523). Statistically, surfactant therapy did not improve survival in patients with ARDS; however, ARDS patients receiving surfactant improved in their pulmonary dynamic compliance and had a tendency to stabilize earlier in gas exchange, allowing us to decrease ventilatory support.
authors.affiliation: Texas Tech Health Sciences Center School of Medicine, Department of Pediatrics, Lubbock 79430, USA.
authors.forename: F
authors.initials: F
authors.lastname: Perez-Benavides
authors.forename: E
authors.initials: E
authors.lastname: Riff
authors.forename: C
authors.initials: C
authors.lastname: Franks
mesh_terms: D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005233:Fatty Alcohols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015701:Near Drowning / Q000150:complications; D010101:Oxygen Consumption; D010767:Phosphorylcholine; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012129:Respiratory Function Tests; D012189:Retrospective Studies
chemical_list: D004338:Drug Combinations; D005233:Fatty Alcohols; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination