Successful use of surfactant to treat severe intrapulmonary hemorrhage after iatrogenic lung injury--A case report.
OBJECTIVE
To describe the beneficial clinical effect of the use of surfactant in a patient with severe unilateral pulmonary hemorrhage after iatrogenic lung injury during corrective surgery for congenital heart defects.


METHODS
Case report.


METHODS
Pediatric cardiac intensive care unit of a tertiary care hospital.


METHODS
An 11-wk-old boy.


METHODS
Intratracheal instillation of 4 mL (100 mg) of surfactant (Survanta) per kilogram of body weight to treat profound and refractory hypoxia and hypercapnia despite high-ventilation pressures, high respiratory rate, and the use of nitric oxide caused by severe pulmonary hemorrhage and atelectasis.


RESULTS
The aggressive ventilation variables could be reduced within the following 2 hrs after surfactant use (from Fio2 0.8, peak inspiratory pressure 36 cm, positive end-expiratory pressure 10 cm, respiratory rate 50, tidal volume 63 mL, and nitric oxide 10 ppm to Fio2 0.4, peak inspiratory pressure 28 cm, positive end-expiratory pressure 10, respiratory rate 40, tidal volume 38 mL, and nitric oxide 5 ppm). There was rapid improvement of clinical variables (inotropic support, chest radiograph) as well as oxygenation (Pao2 from 56 to 149 mm Hg), CO2 exchange (Paco2 from 85 to 39 mm Hg), and acidosis (from pH 7.13 to 7.44).


CONCLUSIONS
The administration of surfactant may be a promising approach to treat severe respiratory failure caused by severe pulmonary hemorrhage.
Haas
Nikolaus A
NA
Department of Paediatric Cardiac Intensive Care, The Prince Charles Hospital, Brisbane, Australia.
Kulasekaran
Karthikeyan
K
Camphausen
Christoph K
CK
D001688:Biological Products / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D002405:Catheterization, Central Venous / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007431:Intraoperative Complications / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D055370:Lung Injury; D008297:Male; D001261:Pulmonary Atelectasis / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000209:etiology
D001688:Biological Products; D011663:Pulmonary Surfactants; C072197:beractant