title: Exogenous surfactant may improve oxygenation but not mortality in adult patients with acute lung injury/acute respiratory distress syndrome: a meta-analysis of 9 clinical trials.
abstract: OBJECTIVE
  To evaluate whether exogenous surfactant therapy may be useful in adult patients with acute lung injury or acute respiratory distress syndrome, using a meta-analysis of published clinical trials.
  
  
  METHODS
  A comprehensive literature search was performed to identify all randomized clinical trials examining the effects of the treatment of acute lung injury/acute respiratory distress syndrome with exogenous surfactant in adults. The primary outcome measurement was mortality 28 or 30 days after randomization. Secondary outcome measurements included a change in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen in the first 24 hours or after 120 hours, the number of ventilation-free days, and any adverse effects. The meta-analysis was performed using the Review Manager 5.0.0 system.
  
  
  METHODS
  Randomized clinical trials.
  
  
  METHODS
  Meta-analysis of 9 trials.
  
  
  RESULTS
  Nine trials involving 2,575 patients were included in the meta-analysis. The analysis showed that treatment with exogenous pulmonary surfactant does not decrease mortality significantly. There was a significant effect of exogenous surfactant treatment on the change in the partial pressure of arterial oxygen/fraction of inspired oxygen ratio in the first 24 hours but this was lost by 120 hours. The duration of ventilation trended lower in surfactant-treated patients but this was not significant. In addition, surfactant-treated patients had a significantly higher risk of adverse effects.
  
  
  CONCLUSIONS
  An exogenous surfactant may improve oxygenation over the first 24 hours after administration. However, treatment does not improve mortality and oxygenation over ≥120 hours after administration and results in a high rate of adverse effects. Therefore, the present data suggest that an exogenous surfactant cannot be considered an effective adjunctive therapy in patients with acute lung injury/acute respiratory distress syndrome.
authors.affiliation: Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Haoyu
authors.initials: H
authors.lastname: Meng
authors.forename: Ying
authors.initials: Y
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.forename: Shukun
authors.initials: S
authors.lastname: Fu
authors.forename: Zhaoyi
authors.initials: Z
authors.lastname: Meng
authors.forename: Melanie
authors.initials: M
authors.lastname: Scott
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
mesh_terms: D055371:Acute Lung Injury / Q000188:drug therapy* / Q000401:mortality*; D000328:Adult; D006801:Humans; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D012121:Respiration, Artificial / Q000401:mortality* / Q000639:trends; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000401:mortality*
chemical_list: D011663:Pulmonary Surfactants