Lavage with diluted surfactant as a treatment option for atelectasis in pediatric intensive care patients

Abstract

The aim of this study was to assess the effect of fiberoptic aspiration and diluted surfactant administration on affected lungs inchildren with atelectasis. A convenience sample of 18 mechanically ventilated children were analyzed in this single center prospectivestudy. The children had fi rst been treated unsuccessfully by respiratory physical therapy, after which they underwent fi beropticaspiration. After aspiration, nine children were randomly selected to receive therapeutic lavage with diluted porcine surfactant; theremaining nine received the same quantity of saline solution. Several parameters of lung function, including positive end-expiratorypressure (PEEP) and oxygenation index (OI), as well as lung x-ray images were determined before aspiration and lavage, then at 6and 12 h after lavage. In both groups, most of the measured parameters showed improvement from baseline at 6 h after treatment.Improvement was even more signifi cant 12 h after treatment. The surfactant group showed signifi cant improvement in comparisonto the saline group. The impact of surfactant administration was most visible on the following parameters 12 h after treatment(p<0.001 in all cases): PEEP 5.22 (SD 0.44) in the saline group vs. 3.44 (SD 0.73) in the surfactant group; OI 3.84 (SD 1.13) vs. 2.1 (SD0.38); and mean airway pressure (MAP) 8.56 (SD 0.88) vs. 6.33 (SD 0.5). In conclusion, fi beroptic aspiration is an effi cient treatment inpediatric intensive care patients. The observed benefi cial eff ects of therapeutic lavage with diluted surfactant should be confi rmedprospectively in a larger number of patients.