Hermon Michael, Burda Gudrun, Male Christoph, Boigner Harald, Ponhold Walter, Khoss August, Strohmaier Wolfgang, Trittenwein Gerhard
Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, Medical University of Vienna, Austria.
Crit Care. 2005;9(6):R718-24. doi: 10.1186/cc3880. Epub 2005 Oct 25.
This study was performed to determine whether surfactant application during extracorporeal membrane oxygenation (ECMO) improves lung volume, pulmonary mechanics, and chest radiographic findings in children with respiratory failure or after cardiac surgery.
This was a retrospective chart review study in a pediatric intensive care unit (PICU). Seven patients received surfactant before weaning from ECMO was started (group S). They were compared to six patients treated with ECMO who did not receive surfactant (group C). These control patients were matched based on age, weight, and underlying diagnosis. Demographic data, ventilator settings, tidal volume, compliance of respiratory system (calculated from tidal volume/(peak inspiratory pressure - positive end-expiratory pressure), and ECMO flow were extracted. Chest radiographs were scored by two blinded and independent radiologists. Changes over time were compared between groups by repeated-measures analysis of variance (time*group interaction). Values are given as percentages of baseline values.
The groups did not differ with regard to demographic data, duration of ECMO, ventilator settings, PICU and hospital days. After application of surfactant, mean tidal volume almost doubled in group S (from 100% before to 186.2%; p = 0.0053). No change was found in group C (100% versus 98.7%). Mean compliance increased significantly (p = 0.0067) in group S (from 100% to 176.1%) compared to group C (100% versus 97.6%). Radiographic scores tended to decrease in group S within 48 h following surfactant application. ECMO flow tended to decrease in group S within 10 h following surfactant application but not in group C. Mortality was not affected by treatment.
Surfactant application may be of benefit in children with respiratory failure treated with ECMO, but these findings need confirmation from prospective studies.
本研究旨在确定体外膜肺氧合（ECMO）期间应用表面活性剂是否能改善呼吸衰竭儿童或心脏手术后儿童的肺容积、肺力学和胸部X线表现。
这是一项在儿科重症监护病房（PICU）进行的回顾性病历审查研究。7例患者在开始撤离ECMO前接受了表面活性剂治疗（S组）。将他们与6例接受ECMO治疗但未接受表面活性剂的患者（C组）进行比较。这些对照患者根据年龄、体重和基础诊断进行匹配。提取人口统计学数据、呼吸机设置、潮气量、呼吸系统顺应性（根据潮气量/（吸气峰压-呼气末正压）计算）和ECMO流量。胸部X线片由两名盲法且独立的放射科医生评分。通过重复测量方差分析（时间*组交互作用）比较两组随时间的变化。数值以基线值的百分比表示。
两组在人口统计学数据、ECMO持续时间、呼吸机设置、PICU住院天数和住院天数方面无差异。应用表面活性剂后，S组平均潮气量几乎翻倍（从之前的100%增至186.2%；p = 0.0053）。C组未发现变化（100%对98.7%）。与C组（100%对97.6%）相比，S组平均顺应性显著增加（p = 0.0067）（从100%增至176.1%）。表面活性剂应用后48小时内，S组的X线评分有下降趋势。表面活性剂应用后10小时内，S组的ECMO流量有下降趋势，但C组没有。死亡率不受治疗影响。
对于接受ECMO治疗的呼吸衰竭儿童，应用表面活性剂可能有益，但这些发现需要前瞻性研究予以证实。
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