ABSTRACT
After impressive results in the treatment of respiratory failure in premature babies, natural surfactant has been proposed in lung pathologies involving suspected surfactant deficiency. Apart from bronchiolitis, in which surfactant was used to stabilize small airways and for its possible antiviral action, research was directed towards pneumonia and sepsis, aspiration and chest trauma, which can lead to adult respiratory distress syndrome. Surfactant bronchoalveolar lavage has been used to 'cleanse' lungs, remove inhibitors and provide sufficient functional surfactant. Failure of surfactant therapy can be caused by insufficient dose, delayed administration, excessive inhibition and catabolism, or by type, severity and complexity of the lung disease (multi-organ failure).
Subject(s)
Pulmonary Surfactants/therapeutic use , Respiratory Distress Syndrome, Newborn/drug therapy , Respiratory Distress Syndrome/drug therapy , Adult , Bronchoalveolar Lavage/methods , Child , Humans , Infant, Newborn , Pulmonary Surfactants/administration & dosageABSTRACT
OBJECTIVE: To evaluate the effects of natural surfactant supplementation in infants, children and adolescents affected by ARDS from different origins in order to reduce lung barotrauma due to artificial ventilation, improve gas exchange, reduce oxygen toxicity and survival. MATERIALS AND METHODS: Two groups, the first consisting of 22 children, 7 days-24 months, and the second of 8 oncohaematologic patients, 2-16 years, affected by ARDS from sepsis, inhalation syndrome and interstitial pneumonia, candidates for ECMO, were treated intratracheally with 50 mg/kg of natural surfactant. Before treatment all patients had been mechanically ventilated using PEEP levels > or = 8 cm H2O and FiO2 > or = 0.6, for at least 24 hours without any improvement in gas exchange. RESULTS: From 15 mins after surfactant administration a progressive improvement in PaO2 was noted which peaked at 3 hours. In two cases in the first group a worsening in PaO2 occurred starting from 12-18 hours, which needed additional doses. All patients in the second group needed additional doses after 12 h. No significant PaCO2 variations were noted until 24 hours. In all cases the chest X-ray improved at 4 hours and clearing was obtained starting from 24 hours in those cases where an additional dose had not been necessary. Computed Tomography confirmed the improvement in lung pathology. All the children in the first group survived except one HIV-positive child. The oncohaematologic children showed an improvement in PaO2 after each administration of surfactant even though they later died due to their initial disease, except one child. COMMENT: Surfactant efficacy in this study appears to depend on the severity of lung pathology and to be strictly connected with early treatment.
