SURFACTANT TREATMENT IN CHILDREN WITH ACQ UIRED RESPIRATORY-DISTRESS SYNDROME

Background and Methods: Exogenous surfactant has been proven to be a v ery effective treatment in neonatal RDS. Also in ARDS it is a promisin g option since it can open nonventilated lung areas. ARDS therapy in p ediatric patients includes modifications of ventilation, permissive hy percapnia, high frequency ventilation, intratracheal ventilation, and finally ECMO. We treated children (age 1-32 months) transferred for EC MO with exogenous surfactant. This therapy was integrated into an algo rithm, including vasodilatation in cases of proven pulmonary hypertens ion, in a tied time frame allowing ECMO as a definite therapy (table 1 ). 6 patients were treated as their FiO(2), was > 0.8 and their mean a irway pressure > 20 mmHg for more than 48 hrs., not responsive to conv entional ventilation strategies and hemodynamic stabilization. They go t 40-380mg/kg bovine surfactant (Alveofact (R), Thomae, Biberach/Germa ny) in to 3 doses over 15 min each time through a special adapter (Alv eodapter) under continuous ventilatory support. OI and AaDO(2) were me asured at 1, 4, 24, 48, 72hrs. and at discharge. At the same times MOD S was scored as was the chest x-ray (20, 21). Results: OI and AaDO(2) decreased significantly (p < 0.01) from a mean 50.2 (+/- 29.9 SD) to 2 5.7 (+/- 17 SD) and 577 (+/- 46 SD) to 413 (+/- 148 SD) in one hour. T his decrease was unchanged until discharge or discontinuation of life support in 2 patients because of severe cerebral damage. In one patien t doses of surfactant of 240 mg/kg twice did not improve OI and AaDO(2 ), he died despite ECMO-therapy. Conclusions: Exogenous surfactant is an effective therapy in pediatric ARDS patients with predominantly par enchymal disease and severe ventilation/perfusion mismatch. Especially for the transport of these patients to an ECMO center it is an instan taneously available, easily applicable therapy. Its value in treatment -algorithms for pediatric ARDS has to be determined in internationally centralized information networks.