title: Exogenous surfactant and alveolar recruitment in the treatment of the acute respiratory distress syndrome.
abstract: OBJECTIVE
  To investigate the effect of alveolar recruitment combined with surfactant administration on children with acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  A prospective, randomized, controlled and sequential study was carried out. Group A (16 children) was treated with both the alveolar recruitment manoeuvres (ARM) and the administration of the surfactant every 8 h for 3 days; group B (15) received the usual treatment only. The alveolar recruitment was carried out by increasing positive end-expiratory pressure 2 by 2 cm H2O to improve the transcutaneous oxygen saturation values up to 88% and 90%. Demographic data, gasometric and ventilator parameters, chest radiography and 28-day mortality were evaluated.
  
  
  RESULTS
  There were no significant differences in baseline characteristics between groups. An hour after treatment, significant differences (P < 0.001) were observed in transcutaneous oxygen saturation (SaO2; Group A: 94.1%, Group B: 89.9%), PaO2/FiO2(212.7 and 126.4) and oxygenation index (OI; 11.4 and 18.5). After 8 h, the differences in SaO2(Group A: 94.6%, Group B: 90.3%), PaO2/FiO2(225.8 and 126.9) and OI (10.8 and 18.4) were also significant (P < 0.001). From the fifth dose of the surfactant, the static compliance (P = 0.0034) and radiological images (P = 0.002) were more greatly improved in group A than in group B. Survival was significantly higher in group A (81.3%) than in group B (26.7%) (P = 0.006).
  
  
  CONCLUSIONS
  The combined treatment of surfactant administration and ARM resulted in a better oxygenation and survival in children with ARDS than when only recruitment was used.
authors.affiliation: Pediatric Intensive Care Department, Pediatric Hospital University Dr. Eduardo Agramonte Piña, Dolores Betancourt No. 2, e/Domingo Puente y Carretera Santa Cruz del Sur, Camagüey, Cuba.
authors.forename: Valentín S
authors.initials: VS
authors.lastname: Rodríguez-Moya
authors.affiliation: Pediatric Intensive Care Department, Pediatric Hospital University Dr. Eduardo Agramonte Piña, Dolores Betancourt No. 2, e/Domingo Puente y Carretera Santa Cruz del Sur, Camagüey, Cuba.
authors.forename: Clara M
authors.initials: CM
authors.lastname: Gallo-Borrero
authors.affiliation: Pediatric Intensive Care Department, Pediatric Hospital University Dr. Eduardo Agramonte Piña, Dolores Betancourt No. 2, e/Domingo Puente y Carretera Santa Cruz del Sur, Camagüey, Cuba.
authors.forename: Daniuris
authors.initials: D
authors.lastname: Santos-Áreas
authors.affiliation: Pediatric Intensive Care Department, Pediatric Hospital University Dr. Eduardo Agramonte Piña, Dolores Betancourt No. 2, e/Domingo Puente y Carretera Santa Cruz del Sur, Camagüey, Cuba.
authors.forename: Ivette A
authors.initials: IA
authors.lastname: Prince-Martínez
authors.affiliation: Division of Production, National Center for Animal and Plant Health, Carretera de Jamaica y Autopista Nacional, San José de las Lajas. Mayabeque, Cuba.
authors.forename: Elaine
authors.initials: E
authors.lastname: Díaz-Casañas
authors.affiliation: Pediatric Intensive Care Department, Gregorio Marañon University General Hospital, c/Puente cesures 1.B 1ºB, 28029, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce Cid
mesh_terms: D000293:Adolescent; D001784:Blood Gas Analysis / Q000379:methods; D001785:Blood Gas Monitoring, Transcutaneous / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D013501:Surface-Active Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D013501:Surface-Active Agents
keywords: alveolar recruitment - pulmonary surfactant - acute respiratory distress syndrome - children