title: WITHDRAWN. Surfactant therapy for bronchiolitis in critically ill infants.
abstract: BACKGROUND
  Viral bronchiolitis is a common cause of respiratory failure in infants and children, and accounts for a significant portion of intensive care unit (ICU) admissions during seasonal epidemics. Currently there is no evidence to support the use of anything but supportive care for this disease. Surfactant is a potentially promising therapy; alterations in its composition have been described in bronchiolitis, and it may play a role in the host immunity for this disease.
  
  
  OBJECTIVE
  To assess the efficacy of exogenous surfactant for the treatment of bronchiolitis in mechanically ventilated infants and children.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 1) which contains the Acute Respiratory Infections Group's Specialized Register; MEDLINE (1966 to Week 1, February 2006); and EMBASE (1990 to September 2005).
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing surfactant with placebo or surfactant with no surfactant in mechanically ventilated infants and children with viral bronchiolitis.
  
  
  METHODS
  Two authors independently extracted data and assessed trial quality. Unpublished data were requested from trial authors when necessary.
  
  
  RESULTS
  Three trials containing a total of 79 patients met the inclusion criteria. No mortality or adverse effects associated with surfactant administration were reported in any of these trials. In the three trials, use of surfactant was associated with a decrease in duration of mechanical ventilation by 2.6 days (95% confidence interval (CI) -5.34 to 0.18 days; P value 0.07) and a decrease in ICU length of stay by 3.3 days (95% CI -6.38 to -0.23 days; P value 0.04). In two studies with 59 patients, in which duration of mechanical ventilation in the control groups was more comparable, surfactant was associated with a decrease in ventilator days by 1.21 days (95% CI 0.75 to 1.67 days) and a decrease in ICU stay by 1.81 days (95% CI 1.19 days to 2.42 days). Individually the studies reported some short term benefit of surfactant on pulmonary mechanics and gas exchange.
  
  
  CONCLUSIONS
  Available data on surfactant were not sufficient to provide reliable estimates of its effects in mechanically ventilated infants and children with bronchiolitis. Future studies should be adequately powered and will need to address unresolved questions regarding which surfactant preparation may be best suited for the treatment of bronchiolitis, the appropriate dose and administration interval, and how the choice of ventilator strategy may modify its effects.
authors.affiliation: Division of Critical Care Medicine, Primary Children's Medical Center, 100 N. Medical Drive, Salt Lake City, Utah, USA, 84113.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ventre
authors.forename: Munib
authors.initials: M
authors.lastname: Haroon
authors.forename: Caroline
authors.initials: C
authors.lastname: Davison
mesh_terms: D001990:Bronchiolitis, Viral / Q000188:drug therapy* / Q000821:virology; D002675:Child, Preschool; D016638:Critical Illness; D006801:Humans; D007223:Infant; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D018357:Respiratory Syncytial Virus Infections
chemical_list: D011663:Pulmonary Surfactants