SURFACTANT TREATMENT
IN NEWBORNS, INFANTS AND CHILDREN
Giuseppe
A. Marraro
Anesthesia and
Intensive Care Dept. Pediatric Intensive Care Unit, Fatebenefratelli &
Ophthalmiatric Hospital, Milano, Italy
Objective: In several lung pathologies in
pediatric age surfactant deficiency can be suspected. After impressive
results in neonatal RDS , the use of surfactant has been widely tested in
meconium aspiration syndrome, inhalation syndrome, pneumonia, ARDS from
different origins and bronchiolitis.
Methods: Both animal (bovine and
porcine) and artificial (with and without proteins) surfactants have been
used in different dosages (50-200 mg/kg). Three different modes of
administration have been used: direct instillation into the distal end of
the tracheal tube, nebulisation in the ventilated gases and selective
endobronchial administration.
Results: 1. The use of surfactant in
meconium aspiration and inhalation syndrome. The complex pathological
change in aspiration and inhalation syndrome includes a chemical
pneumonitis, airway plugging and a secondary deficiency of surfactant.
Exogenous surfactant may be beneficial and bronchoalveolar lavage using
diluted doses of surfactant has been very promising. 2. The use of
surfactant in Acute Respiratory Distress Syndrome (ARDS). Response to
surfactant treatment is unpredictable. Poor response may be due to
inhibition of administered surfactant by plasma components filling the
alveolar space. Better results have been obtained using higher or multiple
doses of surfactant. 3. The
use of surfactant in bronchiolitis is successful reducing severity of
pathologies, lung barotrauma and ICU stay. The treatment is more effective
during artificial ventilation in the presence of PEEP as the latter helps
to keep the terminal bronchioles open.
Conclusion: Surfactant treatment appears
to be very interesting therapy in several lung pathologies in which high
mortality rate is present. The place of surfactant in relation to other
interventions such as high frequency oscillatory ventilation, extra
corporeal membrane oxygenation (ECMO) or inhaled nitric oxide remains
unclear. Several questions remain unsolved:
- how much surfactant to should be used. The efficacy of surfactant
is related to the dose used as well as the severity of the lung pathology.
- when should supplementary doses of surfactant be used, and how
much.
- what is the role of the immunological response.