Abstract

OBJECTIVE To determine prospectively the efficacy of surfactant in acute respiratory distress syndrome.

STUDY DESIGN Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO₂/FiO₂ < 100) (13 with systemic or pulmonary disease and seven with cardiac disease) were treated 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 when the PaO₂/FiO₂ improved by > 20%.

RESULTS After initial surfactant administration the PaO₂/FiO₂increased significantly 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/FiO₂ and OI did not improve in children with cardiac disease. The improvement of the patients who survived was greater than that of those who died.

CONCLUSIONS Surfactant moderately improves oxygenation in some children with severe acute respiratory distress syndrome secondary to pulmonary or systemic disease.