Instillation of calf lung surfactant extract (calfactant) is beneficial inpediatric acute hypoxemic respiratory failure

Objective: Prospective study of the efficacy of calf lung surfactant extrac t in pediatric respiratory failure. Design: Multi-institutional, prospective, randomized, controlled, unblinded trial. Setting: Eight pediatric intensive care units (ICU) of tertiary medical cen ters. Patients: Forty-two children with acute hypoxemic respiratory failure chara cterized by diffuse, bilateral pulmonary infiltrates, need for ventilatory support, and an oxygenation index of greater than or equal to 7. Intervention: Instillation of intratracheal surfactant (80 mL/m(2)). Measurements and Main Results: Ventilator parameters, arterial blood gases, and derived oxygenation and ventilation indices were recorded before and a t intervals after surfactant administration. complications and outcome meas ures, including mortality, duration of mechanical ventilation, and length o f pediatric ICU and hospital stay, were also examined. Patients who receive d surfactant demonstrated rapid improvement In oxygenation and, on average, were extubated 4.2 days (32%) sooner and spent 5 fewer days (30%) in pedia tric intensive care than control patients. There was no difference in morta lity or overall hospital stay. Surfactant administration was associated wit h no serious adverse effects. Conclusions: Administration of calf lung surfactant extract, calfactant, ap pears to be safe and is associated with rapid improvement in oxygenation, e arlier extubation, and decreased requirement for intensive care in children with acute hypoxemic respiratory failure. Further study is needed, however , before widespread use in pediatric respiratory failure can be recommended .