Surfactant therapy for acute respiratory failure in children: a systematic review and meta-analysis.
BACKGROUND
Exogenous surfactant is used to treat acute respiratory failure in children, although the benefits and harms in this setting are not clear. The objective of the present systematic review is to assess the effect of exogenous pulmonary surfactant on all-cause mortality in children mechanically ventilated for acute respiratory failure.


METHODS
We searched the MEDLINE, EMBASE, CINAHL and Ovid Healthstar databases, the bibliographies of included trials and review articles, conference proceedings and trial registries. We included prospective, randomized, controlled trials of pulmonary surfactant that enrolled intubated and mechanically ventilated children with acute respiratory failure. We excluded trials that exclusively enrolled neonates or patients with asthma. Two reviewers independently rated trials for inclusion, extracted data and assessed the methodologic quality. We quantitatively pooled the results of trials, where suitable, using a random effects model.


RESULTS
Six trials randomizing 314 patients were included. Surfactant use reduced mortality (relative risk = 0.7, 95% confidence interval = 0.4 to 0.97, P = 0.04), was associated with increased ventilator-free days (weighted mean difference = 2.5 days, 95% confidence interval = 0.3 to 4.6 days, P = 0.02) and reduced the duration of ventilation (weighted mean difference = 2.3 days, 95% confidence interval = 0.1 to 4.4 days, P = 0.04).


CONCLUSIONS
Surfactant use decreased mortality, was associated with more ventilator-free days and reduced the duration of ventilation. No serious adverse events were reported.
Duffett
Mark
M
Department of Critical Care, McMaster Children's Hospital, 1200 Main St, W, Hamilton, Ontario L8S 4J9, Canada. duffett@hhsc.ca
Choong
Karen
K
Ng
Vivian
V
Randolph
Adrienne
A
Cook
Deborah J
DJ
D002648:Child; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
D011663:Pulmonary Surfactants