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Báo cáo khoa học: " Surfactant for acute respiratory failure in children: where should it fit in our treatment algorithm"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Surfactant for acute respiratory failure in children: where should it fit in our treatment algorithm? | Available online http ccforum.eom 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 This article is online at http ccforum.com content 11 4 148 2007 BioMed Central Ltd Critical Care 2007 11 148 doi 10.1186 cc5951 See related research by Duffett et al. http ccforum.com content 11 3 R66 Abstract In a recent meta-analysis surfactant administration in paediatric acute respiratory failure was associated with improved oxygenation 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 transient hypoxia and hypotension in some patients. Many 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 and colleagues performed a meta-analysis of the six published randomised trials of surfactant therapy in intubated and ventilated children with acute respiratory failure 1 . In all six trials involving a total of 314 patients surfactant administration was associated with beneficial effects including improved oxygenation reduced mortality increased ventilator-free days and reduced duration of ventilation. The meta-analysis provides strong evidence for the use of surfactant in acute respiratory failure in children but where should it fit in our treatment algorithm Optimising the ventilation settings remains the important initial step in management of acute respiratory failure in children requiring intubation. Ensuring that an appropriate tidal volume 6 ml kg is used is important to .