Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis
Abstract Background Acute respiratory distress syndrome (ARDS) in infants undergoing cardiac surgery is associated with significant mortality and prolonged ventilation; surfactant administration may be a useful therapy. The purpose of this study is to evaluate the effect of low-dose exogenous surfac...
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doaj-0dc3357aa64c4feb9e3e23dd4cc8b0b12020-11-25T03:59:53ZengBMCBMC Pulmonary Medicine1471-24662020-08-0120111010.1186/s12890-020-01251-2Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysisRongyuan Zhang0Xu Wang1Shoujun Li2Jun Yan3Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeDepartment of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeDepartment of Surgery, Pediatric Cardiac Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeDepartment of Surgery, Pediatric Cardiac Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeAbstract Background Acute respiratory distress syndrome (ARDS) in infants undergoing cardiac surgery is associated with significant mortality and prolonged ventilation; surfactant administration may be a useful therapy. The purpose of this study is to evaluate the effect of low-dose exogenous surfactant therapy on infants suffering ARDS after cardiac surgery. Methods We conducted a case-control study of infants diagnosed with moderate-to-severe ARDS (PaO2/FiO2 < 150) after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-h of surfactant treatment; and secondary endpoints were the ventilator time and PICU time. Results Twenty-two infants treated with surfactant were matched with 22 controls. Early low-dose (20 mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-h, the surfactant group was much better compared with the control group at the 24-h in OI (difference in average change from baseline, − 6.7 [95% CI, − 9.3 to − 4.1]) (P < 0.01) and ventilation index (VI, mean difference, − 11.9 [95% CI, − 18.1 to − 5.7]) (P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6 h ± 27.2 vs 218.4 h ± 28.7, P < 0.01; 10.7d ± 5.1 vs 17.5d ± 6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis. Conclusions In infants with moderate-to-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones. Randomized controlled trials are needed to explore the effect of surfactant to ARDS of cardiac surgical infants.http://link.springer.com/article/10.1186/s12890-020-01251-2InfantsPulmonary surfactantARDSCardiac surgeryCongenital heart disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rongyuan Zhang Xu Wang Shoujun Li Jun Yan |
spellingShingle |
Rongyuan Zhang Xu Wang Shoujun Li Jun Yan Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis BMC Pulmonary Medicine Infants Pulmonary surfactant ARDS Cardiac surgery Congenital heart disease |
author_facet |
Rongyuan Zhang Xu Wang Shoujun Li Jun Yan |
author_sort |
Rongyuan Zhang |
title |
Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis |
title_short |
Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis |
title_full |
Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis |
title_fullStr |
Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis |
title_full_unstemmed |
Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis |
title_sort |
effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: a retrospective analysis |
publisher |
BMC |
series |
BMC Pulmonary Medicine |
issn |
1471-2466 |
publishDate |
2020-08-01 |
description |
Abstract Background Acute respiratory distress syndrome (ARDS) in infants undergoing cardiac surgery is associated with significant mortality and prolonged ventilation; surfactant administration may be a useful therapy. The purpose of this study is to evaluate the effect of low-dose exogenous surfactant therapy on infants suffering ARDS after cardiac surgery. Methods We conducted a case-control study of infants diagnosed with moderate-to-severe ARDS (PaO2/FiO2 < 150) after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-h of surfactant treatment; and secondary endpoints were the ventilator time and PICU time. Results Twenty-two infants treated with surfactant were matched with 22 controls. Early low-dose (20 mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-h, the surfactant group was much better compared with the control group at the 24-h in OI (difference in average change from baseline, − 6.7 [95% CI, − 9.3 to − 4.1]) (P < 0.01) and ventilation index (VI, mean difference, − 11.9 [95% CI, − 18.1 to − 5.7]) (P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6 h ± 27.2 vs 218.4 h ± 28.7, P < 0.01; 10.7d ± 5.1 vs 17.5d ± 6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis. Conclusions In infants with moderate-to-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones. Randomized controlled trials are needed to explore the effect of surfactant to ARDS of cardiac surgical infants. |
topic |
Infants Pulmonary surfactant ARDS Cardiac surgery Congenital heart disease |
url |
http://link.springer.com/article/10.1186/s12890-020-01251-2 |
work_keys_str_mv |
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