Surfactant therapy for acute respiratory failure in children: a systematic review and meta-analysis

Duffett, Mark; Choong, Karen; Ng, Vivian G.; Randolph, Adrienne G.; Cook, Deborah J.

doi:10.1186/cc5944

Cited by 58 publications

(37 citation statements)

References 27 publications

(34 reference statements)

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“…A recent meta-analysis pointed out that trials paid special attention to the selection of the population, type, dosage, timing and ways of administration of surfactant achieving a statistical significant effect in surfactant treated children in term of reduction of days of mechanical ventilation, days of ICU stay and one study also in mortality. (9) Despite the limitations of our study (we didn't have a control population), it demonstrates very clearly the improved distribution and efficacy of diluted surfactant using lung lavages. A larger, randomized controlled trial is needed to confirm this important finding.…”

Section: Discussionmentioning

confidence: 71%

Diluted porcine surfactant lung lavages in children with severe ARDS

Tortorolo¹,

Chiaretti²,

Pulitanò³

et al. 2009

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Section: Discussionmentioning

confidence: 71%

Diluted porcine surfactant lung lavages in children with severe ARDS

Tortorolo¹,

Chiaretti²,

Pulitanò³

et al. 2009

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“…Dieser pathophysiologische Mechanismus ist die Rationale für eine Substitution mit Surfactant. Es wurde gezeigt, dass die Gabe von Surfactant beim neonatologischen ARDS zu einer Reduktion der Sterblichkeit führen kann [1]. Ähnliche Therapieversuche wurden bei Erwachsenen Patienten mit ARDS durchgeführt.…”

Section: Transfer In Die Praxis Von Georgios Sofianos (Solingen)unclassified

Ist die Gabe von Surfactant bei erwachsenen Patienten mit akutem Atemnotsyndrom berechtigt?

Sofianos¹

2019

Kompass Pneumol

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Introduction: Surfactant is usually deficiency in adult acute respiratory distress syndrome (ARDS) patients and surfactant administration may be a useful therapy. The aim of this study was to perform a meta-analysis of the effect of surfactant administration on outcomes of adult patients with acute respiratory distress syndrome. Methods: PubMed, EMBASE, Medline, Cochrane database, Elsevier, Web of Science and http://clinicaltrials.gov were searched and investigated until December 2017. Randomized controlled trials (RCTs) comparing surfactant administration with general therapy in adult patients with ARDS were enrolled. The primary outcome was mortality (7-10-day, 28-30-day and 90-180-day). Secondary outcome included oxygenation (P_aO₂/FiO₂ ratio). Demographic variables, surfactant administration, and outcomes were retrieved. Sensitivity analyses were used to evaluate the impact of study quality issues on the overall effect. Funnel plot inspection, Egger's and Begger's test were applied to investigate the publication bias. Internal validity was assessed with the risk of bias tool. Random errors were evaluated with trial sequential analysis (TSA). Quality levels were assessed by Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). Results: Eleven RCTs with 3038 patients were identified. Surfactant administration could not improve mortality of adult patients [Risk ratio (RR) (95%CI)) = 1.02(0.93-1.12), p = 0.65]. Subgroup analysis revealed no difference of 7-10-day mortality [RR(95%CI)) = 0.89(0.54-1.49), p = 0.66], 28-30-day mortality[RR(95%CI) = 1.00(0.89-1.12), p = 0.98] and 90-180-day mortality [RR(95%CI) = 1.11(0.94-1.32), p = 0.22] between surfactant group and control group. The change of the P_aO₂/FiO² ratio in adult ARDS patients had no difference [MD(95%CI) = 0.06(− 0.12-0.24), p = 0.5] after surfactant administration. Finally, TSA and GRADE indicated lack of firm evidence for a beneficial effect. Conclusions: Surfactant administration has not been shown to improve mortality and improve oxygenation for adult ARDS patients. Large rigorous randomized trials are needed to explore the effect of surfactant to adult ARDS patients.

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“…(19) On the other hand, paediatrics patients were much more homogenous than adults in regard to underlying diseases (primary and secondary lung injuries), way of administration (endotracheal instillation), dosages (range 50-100 mg/kg) and type of surfactant used (all used natural surfactant with adequate concentration of protein). (19) Willson and Luchetti (21,22) focused their attention on primary lung injured patients and on a restricted group of babies with brochiolitis (those were also more homogenous in terms of age and weight). They were able to show a beneficial effect of exogenous natural surfactant treatment on primary out-come as days on mechanical ventilation, days of ICU LOS and mortality.…”

Section: Paediatric Studiesmentioning

confidence: 99%

Exogenous Surfactant Treatment in Children with ARDS

2013

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Surfactant therapy for acute respiratory failure in children: a systematic review and meta-analysis

Cited by 58 publications

References 27 publications

Diluted porcine surfactant lung lavages in children with severe ARDS

Diluted porcine surfactant lung lavages in children with severe ARDS

Ist die Gabe von Surfactant bei erwachsenen Patienten mit akutem Atemnotsyndrom berechtigt?

Exogenous Surfactant Treatment in Children with ARDS

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