CALF LUNG SURFACTANT EXTRACT IN ACUTE HYPOXEMIC RESPIRATORY-FAILURE IN CHILDREN

Objective: Open-label trial of the safety and short term efficacy of c alf's lung surfactant in pediatric respiratory failure, Design: Multi- institutional, uncontrolled, observational trial, Setting: Six pediatr ic intensive care units of tertiary medical centers. Patients: Twenty- nine children with acute hypoxemic respiratory failure, characterized by diffuse, bilateral, pulmonary infiltrates, need for ventilator supp ort, and an oxygenation index of greater than or equal to 7. Intervent ions: Up to four doses of intratracheal surfactant (80 mL/m(2)). Measu rements and Main Results: Ventilator parameters, arterial blood gases, and derived oxygenation and ventilation indices were recorded before, and at intervals after, surfactant administration. Complications and outcome measures were also noted. There was immediate improvement in o xygenation and moderation of ventilator support associated with surfac tant administration in 24 of 29 patients. A modest but statistically i nsignificant effect was seen with subsequent doses, The only complicat ions occurred in three patients who developed airleaks, two of which w ere coincident with surfactant administration, The overall mortality r ate was 14%, which compares favorably with other published series. Con clusions: Administration of calf's lung surfactant appears to be safe and is associated with rapid improvement in oxygenation and moderation of ventilator support in children with acute hypoxemic respiratory fa ilure. These results set the stage for a randomized, controlled study.