The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts


Theresa R. Schultz, BA, RRT, CPFT, Linda A. Napoli, BS, RRT, RPFT, Suzanne M. Durning, BA, RRT, R. I. Godinez, MD, PhD, The Children's Hospital of Philadelphia, Philadelphia, PA

The delivery method of exogenous surfactant has previously been studied. Clinical application of exogenous surfactant delivery has indicated that the traditional amount of surfactant needed for instillation, in patients outside of the neonatal population, may be prohibitive. It has been established that surfactant dysfunction/inactivation is a prominent feature in the pathophysiology of Adult Respiratory Distress Syndrome (ARDS), suggesting that exogenous surfactant may be advantageous in this patient population. In this case, a 16 month old, 11 kg child, with a history of prematurity, was admitted to our Pediatric Intensive Care Unit in respiratory failure. He was mechanically ventilated on the Servo 300 and, over the course of 3 days, required progressive escalation in support due to the development of ARDS. At this time, he was in the Pressure Regulated Volume Control (PRVC) mode, FiO_{2} of .65, PIP 45 cmH_{2}O, PEEP 10 cm H_{2}O, Paw 28 cm H_{2}O, and a V_{E} of 296 cc/kg/min to maintain normal ventilation and acceptable oxygenation. The decision was made to administer Survanta in a further attempt to optimize lung function. Four ml/kg of Survanta was delivered through a catheter measured 0.5 cm H_{2}O distal to the tracheal tube. The patient received 1.0 FiO_{2} and was positioned as per manufacturer's recommendations during the procedure. Results: Data was collected by use of the Bicore bedside pulmonary function monitor and is as follows:

Before 30 minutes after 2 hours after

PaO_{2}/FiO_{2} 110 185 171

C_{L}(ml/kg/cm H2O) .1 .1 .2

A-a DO_{2} (mmHg) 278 206 184

A sustained favorable response was realized by the improvement of PaO_{2}/FiO_{2} by 36%, C_{L} by 50% and A-a DO_{2} by 34% two hours after the completion of Survanta delivery. Understanding that ARDS is a progressive disease, redosing was performed at 12 hour intervals until progressive improvement ceased to be evident. This patient received 3 total doses. He continued to wean and was extubated 7 days after initial dosing. He was discharged to home 4 days later in his usual state of health. Conclusions: This method of exogenous surfactant administration seemed to be valuable in the treatment of this pediatric patient with ARDS.


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