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Abstract

IntroductionThe purpose of this study was to perform a systematic review and meta-analysis of exogenous surfactant administration to assess whether this therapy may be useful in adult patients with acute respiratory distress syndrome.MethodsWe performed a computerized literature search from 1966 to December 2005 to identify randomized clinical trials. The primary outcome measure was mortality 28–30 days after randomization. Secondary outcome measures included a change in oxygenation (PaO2:FiO2 ratio), the number of ventilation-free days, and the mean duration of ventilation. Meta-analysis was performed using the inverse variance method.ResultsTwo hundred and fifty-one articles were identified. Five studies met our inclusion criteria. Treatment with pulmonary surfactant was not associated with reduced mortality compared with the control group (odds ratio 0.97; 95% confidence interval (CI) 0.73, 1.30). Subgroup analysis revealed no difference between surfactant containing surface protein or not – the pooled odds ratio for mortality was 0.87 (95% CI 0.48, 1.58) for trials using surface protein and the odds ratio was 1.08 (95% CI 0.72, 1.64) for trials without surface protein. The mean difference in change in the PaO2:FiO2 ratio was not significant (P = 0.11). There was a trend for improved oxygenation in the surfactant group (pooled mean change 13.18 mmHg, standard error 8.23 mmHg; 95% CI -2.95, 29.32). The number of ventilation-free days and the mean duration of ventilation could not undergo pooled analysis due to a lack of sufficient data.ConclusionExogenous surfactant may improve oxygenation but has not been shown to improve mortality. Currently, exogenous surfactant cannot be considered an effective adjunctive therapy in acute respiratory distress syndrome.

Effects of interventions on survival in acute respiratory distress syndrome: an umbrella review of 159 published randomized trials and 29 meta-analyses

“…These meta-analyses tested a variety of interventions including low tidal volumes (n=3)[47, 50, 59], prone positioning (n=5)[3, 40, 45, 52, 63], higher PEEP (n=6)[46, 48, 55, 57, 59, 60], HFOV (n=1)[61], non-invasive ventilation (n=1)[44], nitric oxide (n=2)[41, 42], exogenous surfactant (n=3)[49, 54, 65], corticosteroids (n=4)[43, 53, 56, 62], cisatracurium (n=1)[64], inflammation modulating diet (n=2)[58, 67], inhaled β2 agonists (n=1)[66] and sivelestat (n=1)[51] - one meta-analysis tested 2 interventions (low tidal volume and higher PEEP)[59]. Interventions that statistically significantly reduced mortality based on the provided summary effects on the overall population included low tidal volume ventilation (in 3/3 meta-analyses) [47, 50, 59], HFOV (in the single meta-analysis performed) [61], high PEEP (in 3 out of 6 meta-analyses) [46, 55, 57], cisatracurium (in the single meta-analysis performed)[64] and inflammation-modulating diet (in the two meta-analysis performed) [58, 67].…”

Failure to Improve the Oxygenation Index Is a Useful Predictor of Therapy Failure in Acute Respiratory Distress Syndrome Clinical Trials

“…[8, 20, 21] The OI index is a composite index that reflects both the gas exchange and compliance characteristics of the lung. Our analysis suggests that assessing changes in lung compliance is important in understanding factors that impact ARDS outcome.…”

Clinical effects of pulmonary surfactant in combination with nasal continuous positive airway pressure therapy on neonatal respiratory distress syndrome

“…a/AO 2 , which can be used as an indicator for RDS diagnosis and treatment, can reflect the anoxic status under oxygen uptake conditions, the ventilation function and the pulmonary vascular bed and alveolar damage, which is associated with good pulmonary blood flow but has no correlation with extrapulmonary organ failure 15,16. In this study, there were significant differences in OI and a/AO 2 between the two groups 12 hour after treatment (P<0.01), and the difference of a/AO 2 also had statistical significance (P<0.01).…”