Surfactant replacement therapy for adult respiratory distress syndrome in children

Evans, D. A.; Wilmott, Robert W.; Whitsett, Jeffrey A.

doi:10.1002/(sici)1099-0496(199605)21:5<328::aid-ppul9>3.0.co;2-i

Cited by 22 publications

(6 citation statements)

References 71 publications

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“…30 31 However, in some patients rapid instillation produces significant decreases in oxygen saturation, heart rate, and blood pressure, as occurred in three of our patients, probably secondary to the transitory disconnection of the respirator 1630 These effects can be avoided if the surfactant is given through a tracheal tube without interrupting the mechanical ventilation. Another factor that might limit the use of surfactant is its high cost, especially in older children and adolescents 32…”

Section: Discussionmentioning

confidence: 74%

Surfactant treatment for acute respiratory distress syndrome

López‐Herce

Lucas

Carrillo

et al. 1999

Archives of Disease in Childhood

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Objective-To determine prospectively the eYcacy of surfactant in acute respiratory distress syndrome. Study design-Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO 2 /FiO 2 < 100) (13 with systemic or pulmonary disease and seven with cardiac disease) were treated with one to six doses of 50-200 mg/kg of porcine surfactant administered directly into the trachea. The surfactant was considered to be eVective when the PaO 2 /FiO 2 improved by > 20%. Results-After initial surfactant administration the PaO 2 /FiO 2 increased significantly in patients with systemic or pulmonary disease from 68 to 111, and the oxygenation index (OI) diminished significantly from 36.9 to 27.1. The PaO 2 /FiO 2 and OI did not improve in children with cardiac disease. The improvement of the patients who survived was greater than that of those who died. Conclusions-Surfactant moderately improves oxygenation in some children with severe acute respiratory distress syndrome secondary to pulmonary or systemic disease. (Arch Dis Child 1999;80:248-252) Keywords: surfactant; acute respiratory distress syndrome; lung disease Acute respiratory distress syndrome (ARDS) in children can be secondary to multiple causes acting by diVerent mechanisms, such as: direct endothelial damage, decrease and alteration of surfactant, cellular damage by mediators of inflammation (cytokines, complement, products of coagulation, metabolites of arachidonic acid, proteases, and free radicals), and the activation of platelets and leucocytes. These causes produce an alteration in the alveolar capillary membrane, which results in increased permeability and secondary pulmonary oedema.

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Section: Discussionmentioning

confidence: 74%

Surfactant treatment for acute respiratory distress syndrome

López‐Herce

Lucas

Carrillo

et al. 1999

Archives of Disease in Childhood

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“…To date there have been numerous case reports as well as small cohorts of patients given exogenous surfactant that have shown not only that it is safe but that it can improve lung function in patients with ALI/ARDS. [19][20][21][87][88][89][90][91][92][93] However, there have been very few large, controlled clinical trials that have focused on survival. The first was by Anzueto et al who administered aerosolized colfosceril (Exosurf, Glaxo Wellcome, Research Triangle Park, North Carolina), a synthetic surfactant containing no surfactant-associated proteins, to patients with sepsis-induced ARDS for up to 5 days.…”

Section: Current Status Of Surfactant Therapy-targeting Biophysical Dmentioning

confidence: 99%

The Future of Surfactant Therapy during ALI/ARDS

Lewis

Veldhuizen

2006

Semin Respir Crit Care Med

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The importance of pulmonary surfactant in maintaining normal lung function, and the observations that alterations in endogenous surfactant contribute to the lung dysfunction associated with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS), provide a rationale for administering exogenous surfactant in this setting. The results of clinical trials have been variable, however, in part due to the various surfactant preparations used, the different delivery and dosing methods employed, and the types of patients targeted for this therapy. Based on the insight gained from these studies, ongoing trials have modified these factors to optimize outcome, including one trial that is focusing on patients with direct lung insults such as pneumonia and aspiration. The future of surfactant therapy may well take advantage of the recently described host defense functions of this material. Based on extensive in vitro data as well as in vivo animal studies demonstrating the anti-inflammatory and antibacterial functions of various surfactant components, administration of surfactant earlier in the course of the disease, when lung inflammation is present but before severe lung dysfunction occurs, may prove to be optimal. This review discusses both the biophysical and host defense functions of surfactant in the context of novel therapeutic approaches for patients with ALI/ARDS.

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“…These clinical trials have established the safety of exogenous surfactant replacement therapy for patients of all ages with ARDS, and suggest that surfactant replacement may be beneficial for the treatment of ARDS. The one large multicenter trial using an aerosolized synthetic surfactant may have failed due to technical problems with the delivery system, as opposed to failure of the surfactant [218]. Further investigation will determine the efficacy of exogenous surfactant replacement therapy for ARDS as well as the patient populations with ARDS most likely to benefit from surfactant therapy.…”

Section: Adult Respiratory Distress Syndrome (Ards)mentioning

confidence: 99%