Surfactant therapy for acute respiratory distress in infants

Acute respiratory distress syndrome (ARDS) remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes...

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Main Authors: Corrado Moretti, Caterina S. Barbàra, Rosanna Grossi, Stefano Luciani, Fabio Midulla, Paola Papoff
Format: Article
Language:English
Published: Hygeia Press di Corridori Marinella 2014-10-01
Series:Journal of Pediatric and Neonatal Individualized Medicine
Subjects:
Online Access:https://www.jpnim.com/index.php/jpnim/article/view/177
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spelling doaj-d9afba2368194f4db252e1d1949c743c2020-11-25T02:44:04ZengHygeia Press di Corridori MarinellaJournal of Pediatric and Neonatal Individualized Medicine2281-06922014-10-0132e030238e03023810.7363/030238143Surfactant therapy for acute respiratory distress in infantsCorrado Moretti0Caterina S. Barbàra1Rosanna Grossi2Stefano Luciani3Fabio Midulla4Paola Papoff5Department of Paediatrics, Paediatric Emergency and Intensive Care, Sapienza University of Rome, Rome, ItalyDepartment of Paediatrics, Paediatric Emergency and Intensive Care, Sapienza University of Rome, Rome, ItalyDepartment of Paediatrics, Paediatric Emergency and Intensive Care, Sapienza University of Rome, Rome, ItalyDepartment of Paediatrics, Paediatric Emergency and Intensive Care, Sapienza University of Rome, Rome, ItalyDepartment of Paediatrics, Paediatric Emergency and Intensive Care, Sapienza University of Rome, Rome, ItalyDepartment of Paediatrics, Paediatric Emergency and Intensive Care, Sapienza University of Rome, Rome, ItalyAcute respiratory distress syndrome (ARDS) remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Data indicate that adoption of a lung protective ventilation with low tidal volumes and of an open-lung ventilation strategy, characterized by sufficient positive end-expiratory pressure (PEEP) to avoid atelectasis, provides the greatest likelihood of survival and minimizes lung injury. The relative benefits of strategies such as high frequency oscillatory ventilation (HFOV), inhaled nitric oxide (iNO), recruiting manoeuvres and prone position are also considered. Moreover this article examines exogenous lung surfactant replacement therapy and its efficacy in the treatment of paediatric ARDS. In infants and children with acute lung injury the endogenous surfactant system is not only deficient, as observed in preterm infants, but altered via a variety of other mechanisms like inhibition and dysfunction. All factors contribute to the altered physiology seen in ARDS. The role of exogenous surfactant in lung injury beyond the neonatal period is therefore more complex and its limited efficacy may be related to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution or, simply, an inability of the drug to counteract the underlying pathophysiology of ARDS. Several trials have found no clinical benefit from various surfactant supplementation methods in adult patients with ARDS, however some studies have shown that this therapy can improve oxygenation and decrease mortality in some specific clinical conditions of paediatric ARDS. Further studies in the paediatric field are therefore needed to clarify aspects of drug composition, dosage, dilution and timing of delivery and new researches must be carried out on development of more robust pharmaceutical surfactants.   Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy) · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiouhttps://www.jpnim.com/index.php/jpnim/article/view/177acute respiratory distress syndromeinfantslung protective ventilationsurfactantrecruiting maneuversprone position
collection DOAJ
language English
format Article
sources DOAJ
author Corrado Moretti
Caterina S. Barbàra
Rosanna Grossi
Stefano Luciani
Fabio Midulla
Paola Papoff
spellingShingle Corrado Moretti
Caterina S. Barbàra
Rosanna Grossi
Stefano Luciani
Fabio Midulla
Paola Papoff
Surfactant therapy for acute respiratory distress in infants
Journal of Pediatric and Neonatal Individualized Medicine
acute respiratory distress syndrome
infants
lung protective ventilation
surfactant
recruiting maneuvers
prone position
author_facet Corrado Moretti
Caterina S. Barbàra
Rosanna Grossi
Stefano Luciani
Fabio Midulla
Paola Papoff
author_sort Corrado Moretti
title Surfactant therapy for acute respiratory distress in infants
title_short Surfactant therapy for acute respiratory distress in infants
title_full Surfactant therapy for acute respiratory distress in infants
title_fullStr Surfactant therapy for acute respiratory distress in infants
title_full_unstemmed Surfactant therapy for acute respiratory distress in infants
title_sort surfactant therapy for acute respiratory distress in infants
publisher Hygeia Press di Corridori Marinella
series Journal of Pediatric and Neonatal Individualized Medicine
issn 2281-0692
publishDate 2014-10-01
description Acute respiratory distress syndrome (ARDS) remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Data indicate that adoption of a lung protective ventilation with low tidal volumes and of an open-lung ventilation strategy, characterized by sufficient positive end-expiratory pressure (PEEP) to avoid atelectasis, provides the greatest likelihood of survival and minimizes lung injury. The relative benefits of strategies such as high frequency oscillatory ventilation (HFOV), inhaled nitric oxide (iNO), recruiting manoeuvres and prone position are also considered. Moreover this article examines exogenous lung surfactant replacement therapy and its efficacy in the treatment of paediatric ARDS. In infants and children with acute lung injury the endogenous surfactant system is not only deficient, as observed in preterm infants, but altered via a variety of other mechanisms like inhibition and dysfunction. All factors contribute to the altered physiology seen in ARDS. The role of exogenous surfactant in lung injury beyond the neonatal period is therefore more complex and its limited efficacy may be related to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution or, simply, an inability of the drug to counteract the underlying pathophysiology of ARDS. Several trials have found no clinical benefit from various surfactant supplementation methods in adult patients with ARDS, however some studies have shown that this therapy can improve oxygenation and decrease mortality in some specific clinical conditions of paediatric ARDS. Further studies in the paediatric field are therefore needed to clarify aspects of drug composition, dosage, dilution and timing of delivery and new researches must be carried out on development of more robust pharmaceutical surfactants.   Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy) · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou
topic acute respiratory distress syndrome
infants
lung protective ventilation
surfactant
recruiting maneuvers
prone position
url https://www.jpnim.com/index.php/jpnim/article/view/177
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AT stefanoluciani surfactanttherapyforacuterespiratorydistressininfants
AT fabiomidulla surfactanttherapyforacuterespiratorydistressininfants
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