Surfactant treatment for acute respiratory distress syndrome

Objective-To determine prospectively the efficacy of surfactant in acute re spiratory distress syndrome. Study design-Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO2/FiO(2) < 100) (13 wit h systemic or pulmonary disease and seven with cardiac disease) were treate d with one to six doses of 50-200 mg/kg of porcine surfactant administered directly into the trachea. The surfactant was considered to be effective wh en the PaO2/FiO(2) improved by > 20%. Results-After initial surfactant administration the PaO2/FiO(2) increased s ignificantly in patients with systemic or pulmonary disease from 68 to 111, and the oxygenation index (OI) diminished significantly from 36.9 to 27.1. The PaO2/FiO(2) and OI did not improve in children with cardiac disease. T he improvement of the patients who survived was greater than that of those who died. Conclusions-Surfactant moderately improves oxygenation in some children wit h severe acute respiratory distress syndrome secondary to pulmonary or syst emic disease.