Surfactant improves oxygenation in infants and children with pneumonia and acute respiratory distress syndrome.
OBJECTIVE
Pneumonia in childhood may be associated with surfactant dysfunction and severe acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the effects of surfactant treatment on oxygenation in 8 infants (age range: 1 mo to 13 y) with severe respiratory failure owing to viral, bacterial or Pneumocystis Carinii pneumonia.


RESULTS
Instillation of a modified porcine surfactant (Curosurf) improved gas exchange immediately. Median paO2/FiO2 increased from 66 to 140 mmHg (8.8-18.7 kPa; p < 0.01) within 1 h of surfactant treatment. Seven of the 8 patients received multiple surfactant doses. Four patients (50%) died 3-62 d after surfactant treatment. However, 6 patients (75%) were immunodeficient, so that the observed mortality rate was mainly due to the underlying disease.


CONCLUSIONS
Surfactant dysfunction probably plays a role in the pathophysiology of severe paediatric ARDS triggered by pneumonia, as it was found that surfactant instillation rapidly improved gas exchange in the majority of the affected infants in our study. Larger randomized controlled studies are necessary to evaluate the effects of surfactant treatment on morbidity and mortality.
Herting
E
E
eherting@med.uni-goettingen.de
Möller
O
O
Schiffmann
J H
JH
Robertson
B
B
D000293:Adolescent; D001688:Biological Products; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010743:Phospholipids; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000503:physiopathology*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000503:physiopathology*
D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa