Porcine-derived surfactant treatment of severe bronchiolitis.
BACKGROUND
It is hypothesized that surfactant treatment helps to improve severe bronchiolitis by restoring surfactant system activity. This study aims to assess the effect of surfactant on gas exchange, peak inspiratory pressure and duration of mechanical ventilation and intensive care unit (ICU) stay in children with severe bronchiolitis.


METHODS
Twenty children with bronchiolitis requiring mechanical ventilation were randomly assigned to one of two groups (10 patients each). Group A was treated with continuous positive pressure ventilation (CPPV) plus surfactant. Group B was treated with CPPV only. Porcine-derived surfactant, 50 mg/kg body weight, was instilled into the trachea. Arterial tension of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, arterial tension of carbon dioxide (PaCO2), and peak inspiratory pressure (PIP) were assessed. Heart rate and non-invasive arterial blood pressure were monitored. The duration of CPPV and the length of ICU stay were also recorded. Finally, the incidence of complications and the survival rate were assessed.


RESULTS
In group A, the PaO2/FiO2 ratio significantly improved from 1 h and a reduction in PaCO2 was noted from 12 h. A reduction of PIP was observed from 3 h. The duration of CPPV and the length of ICU stay were reduced in group A. No complications were reported in either group and all children survived.


CONCLUSIONS
Surfactant treatment of severe bronchiolitis appeared to improve gas exchange, reduce PIP and shorten CPPV and ICU stay. However, these initial results must be confirmed by a larger and more rigorously controlled study.
Luchetti
M
M
Department of Anaesthesia and Intensive Care, Fatebenefratelli and Ophthalmiatric Hospital, Milano, Italy.
Casiraghi
G
G
Valsecchi
R
R
Galassini
E
E
Marraro
G
G
D000704:Analysis of Variance; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D001988:Bronchiolitis / Q000188:drug therapy*; D002245:Carbon Dioxide / Q000097:blood; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D001239:Inhalation / Q000187:drug effects; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D011312:Pressure; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012123:Pulmonary Ventilation / Q000187:drug effects; D012121:Respiration, Artificial; D015996:Survival Rate; D013552:Swine
D011663:Pulmonary Surfactants; D002245:Carbon Dioxide; D010100:Oxygen