Scenario

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’).

Commentary

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 …