Diluted porcine surfactant lung lavages in children with severe ARDS
1,Pediatric Intensive Care Unit Emergency Department A. Gemelli Hospital of Rome
DOI: 10.22514/SV42.102009.3 Vol.4,Issue 2,October 2009 pp.16-19
Published: 28 October 2009
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
ARDS, pulmonary surfac-tant, bronchoalveolar lavages, child
LUCA TORTOROLO,ANTONIO CHIARETTI,SILVIA PULITANÒ,ORAZIO GENOVESE,GIORGIO CONTI. Diluted porcine surfactant lung lavages in children with severe ARDS . Signa Vitae. 2009. 4(2);16-19.
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