SURFACTANT THERAPY IN ACUTE RESPIRATORY-DISTRESS SYNDROME (ARDS) OF CHILDREN

ARDS in adults has recently been shown to improve by exogenous surfact ant therapy. However, regarding surfactant therapy in children with AR DS only few data exist to date. Therefore, we analyzed retrospectively 18 children with ARDS, who were treated with 69 endotracheal applicat ions of bovine surfactant. Patients with good clinical response receiv ed repeated surfactant applications, usually at 8-24 hours intervals. The causes of ARDS were pneumonia, lung hemorrhage, and toxins liberat ed during surgery. The interval between first signs of ARDS and surfac tant application varied from 2.2 to 67.5 days. Within 30 to 120 min af ter surfactant application the PaO2/FiO2-ratio, the AaDO2, and the oxy genation index (OI) improved significantly. Responders to therapy had a 40% higher probability of survival than non-responders (p < 0.0001). Five of 18 patients (28%) survived. In all studied cases, surfactant deficiency and grossly impaired lung function could be demonstrated pr ior to treatment. We conclude that surfactant replacement therapy in c hildren with ARDS improves gas exchange significantly.