title: Bronchoscopic surfactant administration in pediatric patients with persistent lobar atelectasis.
abstract: Persistent lobar atelectasis in pediatric patients on mechanical ventilation results in impaired gas exchange and lung mechanics and contributes to a further need for mechanical ventilation. The most common types of atelectasis in children are resorption atelectasis following airway obstruction, and atelectasis due to surfactant deficiency or dysfunction. We aimed to determine whether bronchoscopic suctioning and surfactant application to atelectatic lung segments would result in improved oxygenation, ventilation, chest X-ray scoring, and early extubation. Five children with heterogeneous lung diseases (aged between 7 months and 15 years) were treated with a diluted surfactant preparation (Curosurf) in a concentration of 5-10 mg/ml (total dose 120-240 mg) which was instilled into the affected segments. Outcome parameters were gas exchange, radiographic resolution of atelectasis and extubation. All mechanically ventilated patients could be extubated within 24 h following the intervention. Bronchoscopic surfactant application could be carried out without adverse effects and brought improvements in oxygenation, respiratory rate, and partial or complete resolution of atelectases without recurrence.
authors.affiliation: Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany. m.krause@pediatrics.uni-kiel.de
authors.forename: Martin F
authors.initials: MF
authors.lastname: Krause
authors.forename: Philipp
authors.initials: P
authors.lastname: von Bismarck
authors.forename: Hans C
authors.initials: HC
authors.lastname: Oppermann
authors.forename: Tobias
authors.initials: T
authors.lastname: Ankermann
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy; D001261:Pulmonary Atelectasis / Q000188:drug therapy* / Q000209:etiology; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants