[Use of the exogenous surfactant curosurf in combined therapy for acute respiratory failure in children after cardiosurgical interventions].

This study was undertaken to evaluate the effectiveness and safety of use of an exogenous surfactant in combined therapy for acute respiratory failure in children after cardiac surgery. In 2003 to 2004, the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, used Curosurf in 58 infants undergone cardiac surgery. The infants' age ranged from 1 day to 27 months (4.6 +/- 0.75 months); the body weight was 1.1 to 14.8 kg (4.9 +/- 0.69 kg). According to the indications for replacement therapy with Curosurf, all the patients were divided into 4 groups: 1) 19 patients with acute pulmonary lesion syndrome; 2) 12 patients with bilateral pneumonia; 3) 22 infants with recurrent atelectases, and 4) 5 patients with paresis of the cupula of the diaphragm. Group 1 patients receiving the exogenous surfactant showed a significant increase in oxygenation and Cdyn, which allowed a significant reduction in the level of respiratory support. Group 2 patients were found to have similar changes, less pronounced as they were, in gas exchange and the mechanics of respiration. In most patients with recurrent atelectases, a steady-state smoothing-out of the latter could be achieved. In Group 4 patients, the exogenous surfactant did not affect the duration of artificial ventilation. Complications due to the administration of the exogenous surfactant (pneumothorax, short-term blood desaturation) were encountered rarely and readily arrested. As a whole, Curosurf is an effective component of combined intensive therapy for acute respiratory failure in pediatric cardiosurgery.