Diluted porcine surfactant  lung lavages in children with severe ARDS 

Acute respiratory distress syndrome (ARDS) is characterized by damage to the arteriolar-capillary endothelium and alveolar epithelium that leads to surfactant deficiency and atelectasis. Alveolar collapse and pulmonary edema will further induce surfactant inactivation. Surfactant supplementation has been suggested but results are unpredictable. Poor response may be due to inhibition of administered surfactant by plasma components filling the alveolar space, severity of lung injury, time of surfactant application and inadequate dose. We report the course of gas exchange and pulmonary mechanics after insti-llation of surfactant in 14 children (3 months-7 years) with severe ARDS, defined as an oxygenation index (OI) > 30 and a 

partial pressure of oxygen/ fraction of Inspired oxygen (PaO2/FiO2) <150 . We used a diluted concentration of Curosurf (8 mg/ml) divided into 4 aliquots, for a total dose of 25 mg/kg. An additional aliquot was used for bronchoalveolar lavage 

before surfactant treatment.  

 All children showed a dramatic response to surfactant with rapid and progressive increase in compliance and improve-ment of all respiratory mechanics. Mechanical ventilation settings were rapidly reduced and gas exchange improved with 

a PaO2/FiO2 >200 for more than 12 hours.

Diluted surfactant lung lavages were able to increase blood gas exchange in all our patients despite previously severe gas 

exchange impairment.

ARDS, pulmonary surfac-tant, bronchoalveolar lavages, child

1. Bush A. Up Date in pediatric lung disease 2008. Am J Respir Crit Care Med 2009;179:637-49.

2. Dahlem P, van Aalderen WM, Bos AP. Pediatric acute lung injury. Pediatric Respir Rev 2007;8:348-62.

3. Willson DF, Chess PR, Notter RH. Surfactant for pediatric acute lung injury. Pediatric Clin North Am 2008;55:545-75.

4. Marraro GA, Lucchetti M, Spada C, Galassini E, Giossi M, Piero AM. Selective medicated (normal saline and exogenous surfactant) bron-choalveolar lavage in severe aspiration syndrome in children. Pediatr Crit Care Med 2007;8:505-6.

5. Luchetti M, Ferrero F, Gallini C, Natale A, Pigna A, Tortorolo L, et al. Multicenter, randomized, controller study of porcine .surfactant in severe respiratory syncitial virus-induced respiratory failure. Pediatr Crit Care Med 2002;3:261-6.

6. Meister J, Venkataraman B, Ramirez M, Uyehara FT, Killeen J, Ku T, et al. Lavage administration of diluted surfactant in a piglet model of meconium aspiration. Lung 2004;182:227-40.

7. Gommers D, Eijking P, So Kl, van’t Veen A, Lachmann B. Bronchoalveolar lavage with a diluted surfactant suspension prior to surfactant instillation improves the effectiveness of surfactant therapy in experimental acute respiratory distress syndrome (ARDS). Intensive Care Med 1998;24:494-500.

8. Cochrane G, Revak S. Surfactant lavage treatment in a model of respiratory distress syndrome. Chest 1999;116:85-6.

9. Duffett M, Choong K, Ng V, Randolph A, Cook DJ. Surfactant therapy for acute respiratory failure in children: a systematic review and meta-analysis. Crit Care 2007;11:66.