Arch Dis Child doi:10.1136/archdischild-2013-303633
  • Archimedes

Should critically ill children with acute respiratory failure be treated with surfactant?

  1. Jan Hau Lee2
  1. 1Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
  2. 2Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
  1. Correspondence to Dr Zhi Min Ng, Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; ng.zhi.min{at}
  • Received 7 January 2013
  • Revised 10 February 2013
  • Accepted 15 April 2013
  • Published Online First 16 May 2013


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’).

Search outcome

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 …

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