Surfactant for acute respiratory failure in children where should it fit in our treatment algorithm 英文参考文献.docVIP

Available online /content/11/4/148 Commentary Surfactant for acute respiratory failure in children: where should it fit in our treatment algorithm? Margrid Schindler Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK Corresponding author: Margrid Schindler, Margrid.Schindler@ubht.nhs.uk Published: 19 July 2007 Critical Care 2007, 11:148 (doi:10.1186/cc5951) This article is online at /content/11/4/148 ? 2007 BioMed Central Ltd See related research by Duffett et al., /content/11/3/R66 Abstract Using evidence-based medicine, the evidence is strongest for the use of surfactant. Next favoured would be steroids, which have been shown to improve oxygenation, to shorten the In a recent meta-analysis, surfactant administration in paediatric acute respiratory failure was associated with improved oxygena- tion, reduced mortality, increased ventilator-free days and reduced duration of ventilation. Surfactant is expensive, however, and its use involves installation of large volumes into the lungs, resulting in hypoxia and hypotension in some patients. Many duration of mechanical ventilation and to reduce the multiorgan failure score in two randomised trials in adults [3,4]; this therapy would then be followed by high-frequency oscillatory ventilation, which reduced the oxygen requirement in survivors in the one published randomised trial in children [5]. Inhaled nitric oxide would rank last in this list as, although it improved oxygenation in the first 24 hours, its use has not been associated with any significant change in any other outcome marker [6]. transient questions also remain unanswered, such the as optimum dosage and the timing of administration of surfactant. The merits of surfactant administration should therefore still be decided on an individual case-by-case basis. Duffett a