Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
Department of Surgery, Pediatric Cardiac Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
BMC Pulm Med. 2020 Aug 6;20(1):210. doi: 10.1186/s12890-020-01251-2.
Acute respiratory distress syndrome (ARDS) in infants undergoing cardiac surgery is associated with significant mortality and prolonged ventilation; surfactant administration may be a useful therapy. The purpose of this study is to evaluate the effect of low-dose exogenous surfactant therapy on infants suffering ARDS after cardiac surgery.
We conducted a case-control study of infants diagnosed with moderate-to-severe ARDS (PaO/FiO < 150) after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-h of surfactant treatment; and secondary endpoints were the ventilator time and PICU time.
Twenty-two infants treated with surfactant were matched with 22 controls. Early low-dose (20 mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-h, the surfactant group was much better compared with the control group at the 24-h in OI (difference in average change from baseline, - 6.7 [95% CI, - 9.3 to - 4.1]) (P < 0.01) and ventilation index (VI, mean difference, - 11.9 [95% CI, - 18.1 to - 5.7]) (P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6 h ± 27.2 vs 218.4 h ± 28.7, P < 0.01; 10.7d ± 5.1 vs 17.5d ± 6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis.
In infants with moderate-to-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones. Randomized controlled trials are needed to explore the effect of surfactant to ARDS of cardiac surgical infants.
婴儿心脏手术后发生急性呼吸窘迫综合征（ARDS）与死亡率显著升高和通气时间延长有关；表面活性剂的应用可能是一种有用的治疗方法。本研究的目的是评估小剂量外源性表面活性剂治疗对心脏手术后发生 ARDS 的婴儿的影响。
我们对心脏手术后诊断为中重度 ARDS（PaO/FiO < 150）的婴儿进行了病例对照研究。病例定义为接受表面活性剂和标准治疗的患者，而对照定义为接受标准治疗的患者。主要终点是表面活性剂治疗 24 小时后氧合指数（OI）的改善；次要终点是呼吸机时间和 PICU 时间。
22 例接受表面活性剂治疗的婴儿与 22 例对照匹配。早期小剂量（20mg/kg）表面活性剂治疗与改善结局相关。在表面活性剂治疗 24 小时后，与对照组相比，表面活性剂组在 24 小时 OI（平均基线变化差值，-6.7[95%CI，-9.3 至-4.1]）（P < 0.01）和通气指数（VI，平均差值，-11.9[95%CI，-18.1 至-5.7]）（P < 0.01）方面的改善更为显著。与对照组相比，表面活性剂组的通气时间和 PICU 时间明显缩短（133.6 h ± 27.2 与 218.4 h ± 28.7，P < 0.01；10.7 d ± 5.1 与 17.5 d ± 6.8，P < 0.01）。初步探索性分析表明，3 个月以下的婴儿在 OI 和 VI 方面比 3 个月以上的婴儿受益更多。
对于心脏手术后中重度 ARDS 的婴儿，早期小剂量外源性表面活性剂治疗可明显改善氧合，减少机械通气时间和 PICU 时间。3 个月以下的婴儿可能比 3 个月以上的婴儿获得更多的氧合益处。需要进行随机对照试验来探讨表面活性剂对心脏手术婴儿 ARDS 的作用。
