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A 9-year-old child with relapsed acute lymphoblastic leukaemia postbone marrow transplant was admitted to the children's intensive care unit (ICU) for non-neutropenic fever with worsening respiratory distress that required mechanical ventilation. Despite broad-spectrum antimicrobials, serial chest radiographs showed worsening bilateral infiltrates and increasing mechanical ventilatory requirements. As the registrar in the unit, you wondered if intratracheal surfactant would be beneficial in treating this child with acute respiratory failure.
Structured clinical question
In critically ill children with acute respiratory failure (patient), does treatment with surfactant (intervention) improve gaseous exchange and shorten duration of mechanical ventilation and length of ICU stay (outcomes)?
Search strategy and outcome
Secondary source—Cochrane Database of Systematic Review, BestBETs
Primary source—PubMed, CINAHL, Web of Science
Search terms were (‘children’) AND (‘surfactant’) AND (‘acute respiratory distress syndrome’ OR ‘adult respiratory distress syndrome’ OR ‘acute lung injury’ OR ‘acute respiratory failure’).
The Cochrane database yielded one relevant review. BestBETs yielded one relevant review. Pubmed, CINAHL and Web of Science yielded 209, 55 and 324 hits, respectively, from which seven relevant randomised controlled studies were identified. Three of these studies were included in the Cochrane review.
Qualitative and quantitative deficiency of surfactant play a role in the development of acute respiratory failure in infants, children and adults.1 ,2 An Archimedes review published in 2003 looking at the use of surfactant in mechanically ventilated infants with severe bronchiolitis suggested …