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Signa vitae : journal for intesive care and emergency medicine, Vol. 4 No. 2, 2009.

Original scientific paper

Diluted porcine surfactant lung lavages in children with severe ARDS

LUCA TORTOROLO ; Pediatric Intensive Care Unit; Emergency Department A. Gemelli; Hospital of Rome; Via A. Caroncini 27; 00197 Roma, Italy
ANTONIO CHIARETTI ; Pediatric Intensive Care Unit; Emergency Department A. Gemelli; Hospital of Rome; Via A. Caroncini 27; 00197 Roma, Italy
SILVIA PULITANÒ ; Pediatric Intensive Care Unit; Emergency Department A. Gemelli; Hospital of Rome; Via A. Caroncini 27; 00197 Roma, Italy
ORAZIO GENOVESE ; Pediatric Intensive Care Unit; Emergency Department A. Gemelli; Hospital of Rome; Via A. Caroncini 27; 00197 Roma, Italy
GIORGIO CONTI ; Pediatric Intensive Care Unit; Emergency Department A. Gemelli; Hospital of Rome; Via A. Caroncini 27; 00197 Roma, Italy

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Abstract

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 instillation 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 improvement 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.

Keywords

ARDS; pulmonary surfactant; bronchoalveolar lavages; child

Hrčak ID:

42332

URI

https://hrcak.srce.hr/42332

Publication date:

1.10.2009.

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