Shein Steven L, Maul Timothy M, Li Hong, Kurland Geoffrey
From the *Department of Pediatric Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; †Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio; and Departments of ‡Pediatric Cardiothoracic Surgery and §Pediatric Pulmonology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
ASAIO J. 2015 Nov-Dec;61(6):682-7. doi: 10.1097/MAT.0000000000000266.
Administering surfactant during pediatric extracorporeal membrane oxygenation (ECMO) may influence important clinical variables but has been insufficiently described. Ninety-six courses of ECMO from our center were retrospectively assessed, and 89 surfactant doses were identified during 37 ECMO courses. Surfactant administration was associated with a respiratory indication for ECMO and increased durations of ECMO and positive pressure ventilation. Hospital survival was 64.9% (24) in surfactant-treated ECMO courses and 72.9% (43) otherwise (p = 0.41). Dynamic compliance of the respiratory system (Cdyn; shown as least squares mean [standard error] in ml/cm H2O/kg by mixed-effects modeling) increased significantly from 0.34 (0.03) before surfactant to 0.40 (0.03) within 12 hours (p = 0.023) and to 0.45 (0.03) within 24 hours (p < 0.001) of surfactant administration. Other mechanical ventilator parameters, ECMO settings, and arterial blood gas results did not differ significantly after surfactant administration. Among surfactant recipients, significantly increased Cdyn was observed in the nonsurgical group (n = 20) but not in the cardiac surgery group (n = 17). In conclusion, respiratory system compliance is increased after surfactant administration and noncardiac surgical patients may preferentially benefit from this therapy. Surfactant administration was associated with longer durations of mechanical support, but not with unfavorable mortality.
在小儿体外膜肺氧合（ECMO）期间给予表面活性剂可能会影响重要的临床变量，但对此描述尚不充分。我们中心对96例ECMO疗程进行了回顾性评估，在37例ECMO疗程中确定了89次表面活性剂给药。表面活性剂给药与ECMO的呼吸指征以及ECMO和正压通气时间延长有关。在接受表面活性剂治疗的ECMO疗程中，医院生存率为64.9%（24例），未接受表面活性剂治疗的为72.9%（43例）（p = 0.41）。呼吸系统的动态顺应性（Cdyn；通过混合效应模型以毫升/厘米水柱/千克表示为最小二乘均值[标准误差]）在给予表面活性剂前为0.34（0.03），在给药后12小时内显著增加至0.40（0.03）（p = 0.023），在24小时内增加至0.45（0.03）（p < 0.001）。给予表面活性剂后，其他机械通气参数、ECMO设置和动脉血气结果无显著差异。在接受表面活性剂治疗的患者中，非手术组（n = 20）的Cdyn显著增加，而心脏手术组（n = 17）则未增加。总之，给予表面活性剂后呼吸系统顺应性增加，非心脏手术患者可能优先从该治疗中获益。表面活性剂给药与机械支持时间延长有关，但与不良死亡率无关。
