Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Eur J Cardiothorac Surg. 2011 Sep;40(3):557-62. doi: 10.1016/j.ejcts.2011.01.008. Epub 2011 Mar 2.
The efficiency of exogenous pulmonary surfactant for pediatric patients suffering acute respiratory distress syndrome after cardiac surgery remains indeterminate. This study explored (1) whether use of exogenous surfactant improved recovery for patients suffering postoperative acute respiratory distress syndrome and (2) whether kinetic analysis of pulmonary functional change was helpful to indicate an appropriate dosing scheme.
Pediatric patients receiving an exogenous surfactant due to acute respiratory distress syndrome after cardiac surgery for congenital heart defects were reviewed from chart records. They were compared with patients without its use despite the same postoperative complication. Oxygenation index and ventilation index were calculated and fitted with a monoexponential function before and after its use. Other outcomes including chest radiography, duration of mechanical ventilation, and intensive care unit and hospital stay were also analyzed.
All patients developing postoperative acute respiratory distress syndrome were infants. Among them, 19 infants received surfactant administration (Curosurf, 100 mg kg⁻¹, treatment group). Twenty-four infants without its administration served as control, though also suffering from the same complication. All infants receiving surfactant survived, whereas three infants in the control group died. The duration of mechanical ventilation or hospital stay was significantly shorter after surfactant administration. The infants received either one (n = 13, one-dose subgroup) or two doses (n = 6, two-dose subgroup) before successful weaning from the ventilator. After the first dose was administered, the maximal rates of oxygen index and ventilation index change were significantly higher for infants in the one-dose subgroup (oxygen index: 2.3 ± 0.9 vs 0.8 ± 0.7, p = 0.009, ventilation index: 12.9 ± 3.8 vs 3.9 ± 2.5, p = 0.007). Shortly thereafter (< 12 h), both parameters in the two-dose subgroup deteriorated and a second dose was administered 24h later.
Exogenous pulmonary surfactant is an efficient medication for infants suffering acute respiratory distress syndrome after cardiac surgery. Kinetics analysis of functional change after initial surfactant use may be referred for early determination of an optimal dosing scheme.
外源性肺表面活性剂治疗心脏手术后小儿急性呼吸窘迫综合征的疗效尚不确定。本研究探讨了（1）外源性肺表面活性剂是否改善了术后急性呼吸窘迫综合征患儿的恢复情况，（2）肺功能变化的动力学分析是否有助于确定合适的给药方案。
从病历记录中回顾了因先天性心脏病心脏手术后发生急性呼吸窘迫综合征而接受外源性肺表面活性剂治疗的儿科患者。将他们与尽管有相同术后并发症但未使用该药物的患者进行比较。在使用前后，计算氧合指数和通气指数，并拟合单指数函数。还分析了其他结果，包括胸部 X 线摄影、机械通气时间、重症监护病房和住院时间。
所有发生术后急性呼吸窘迫综合征的患儿均为婴儿。其中，19 名患儿接受了表面活性剂治疗（Curosurf，100mg/kg，治疗组）。24 名未接受治疗的患儿作为对照，尽管也患有同样的并发症。所有接受表面活性剂治疗的患儿均存活，而对照组中有 3 名患儿死亡。使用表面活性剂后，机械通气或住院时间明显缩短。在成功脱离呼吸机之前，患儿接受了一次（n=13，单剂量亚组）或两次剂量（n=6，双剂量亚组）。首次给药后，单剂量亚组患儿的氧指数和通气指数变化的最大速率明显更高（氧指数：2.3±0.9 对 0.8±0.7，p=0.009，通气指数：12.9±3.8 对 3.9±2.5，p=0.007）。此后不久（<12h），双剂量亚组的两个参数均恶化，并在 24h 后给予第二次剂量。
外源性肺表面活性剂是治疗心脏手术后小儿急性呼吸窘迫综合征的有效药物。初始肺表面活性剂使用后功能变化的动力学分析可用于早期确定最佳给药方案。
