Military Faculty of Medicine, Department of Military Surgery, University of Defence, Hradec Kralove, Czech Republic.
Department of Pediatric Surgery and Traumatology, University Hospital Hradec Kralove, Faculty of Medicine Hradec Kralove, Charles University, Prague, Czech Republic.
Clin Respir J. 2024 May;18(5):e13776. doi: 10.1111/crj.13776.
This systematic review aimed to summarize the available data on the treatment of pulmonary contusions with exogenous surfactants, determine whether this treatment benefits patients with severe pulmonary contusions, and evaluate the optimal type of surfactant, method of administration, and drug concentration. Three databases (MEDline, Scopus, and Web of Science) were searched using the following keywords: pulmonary surfactant, surface-active agents, exogenous surfactant, pulmonary contusion, and lung contusion for articles published between 1945 and February 2023, with no language restrictions. Four reviewers independently rated the studies for inclusion, and the other four reviewers resolved conflicts. Of the 100 articles screened, six articles were included in the review. Owing to the limited number of papers on this topic, various types of studies were included (two clinical studies, two experiments, and two case reports). In all the studies, surfactant administration improved the selected ventilation parameters. The most frequently used type of surfactant was Curosurf® in the concentration of 25 mg/kg of ideal body weight. In most studies, the administration of a surfactant by bronchoscopy into the segmental bronchi was the preferable way of administration. In both clinical studies, patients who received surfactants required shorter ventilation times. The administration of exogenous surfactants improved ventilatory parameters and, thus, reduced the need for less aggressive artificial lung ventilation and ventilation days. The animal-derived surfactant Curosurf® seems to be the most suitable substance; however, the ideal concentration remains unclear. The ideal route of administration involves a bronchoscope in the segmental bronchi.
本系统评价旨在总结外源性表面活性剂治疗肺挫伤的现有数据，确定该治疗方法是否有益于重症肺挫伤患者，并评估最佳的表面活性剂类型、给药方法和药物浓度。使用以下关键词在三个数据库（MEDline、Scopus 和 Web of Science）中搜索 1945 年至 2023 年 2 月发表的文章，无语言限制：肺表面活性剂、表面活性剂、外源性表面活性剂、肺挫伤和肺挫伤。四名评审员独立评估研究纳入情况，另外四名评审员解决冲突。在筛选出的 100 篇文章中，有 6 篇文章纳入了综述。由于关于这个主题的论文数量有限，因此纳入了各种类型的研究（两项临床研究、两项实验和两项病例报告）。在所有研究中，表面活性剂给药均改善了所选通气参数。最常使用的表面活性剂类型是 Curosurf®，剂量为理想体重的 25mg/kg。在大多数研究中，经支气管镜向肺段支气管内给药是首选的给药途径。在两项临床研究中，接受表面活性剂治疗的患者需要较短的通气时间。外源性表面活性剂的给药改善了通气参数，从而减少了对非侵袭性人工通气和通气天数的需求。动物源性表面活性剂 Curosurf®似乎是最合适的物质；然而，理想的浓度尚不清楚。理想的给药途径涉及支气管镜下的肺段支气管。
