Treatment with bovine surfactant in severe acute respiratory distress syndrome in children: A randomized multicenter study

Jens Christian Möller*, Thomas Schaible, Claudia Roll, Jan Holger Schiffmann, Lutz Bindl, Lothar Schrod, Irwin Reiss, Martina Kohl, Subha Demirakca, Roland Hentschel, Thomas Paul, Anne Vierzig, Peter Groneck, Heide Von Seefeld, Helmut Schumacher, Ludwig Gortner, H. Hörnchen, U. Merz, V. Varnholt, S. BuderusJ. Scharf, L. Hanssler, T. Höhn, H. Schiffmann, E. Herting, S. Rödl, G. Zobel, M. Sasse, B. Simma, R. Trawöger, B. Roth, R. G. Huth, C. F. Wippermann, P. Lasch, S. Voßbeck, F. Pohlandt, G. Hofmann, P. Schmidt

*Corresponding author for this work
75 Citations (Scopus)


Objective: To determine whether bovine surfactant given in cases of severe pediatric acute respiratory distress syndrome (ARDS) improves oxygenation. Design: Single-center study with 19 patients, followed by a multicenter randomized comparison of surfactant with a standardized treatment algorithm. Primary endpoint PaO2/FIO2 at 48 h, secondary endpoints: PaO2/FIO2 at 2, 4, 12, and 24 h, survival, survival without rescue, days on ventilator, subgroups analyzed by analysis of variance to identify patients who might benefit from surfactant. Setting: Multicenter study in 19 reference centers for ARDS. Patients: Children after the 44th postconceptional week and under 14 years old, admitted for at least 4 h, ventilated for 12-120 h, and without heart failure or chronic lung disease. In the multicenter study 35 patients were recruited; 20 were randomized to the surfactant group and 15 to the nonsurfactant group. Decreasing recruitment of patients led to a preliminary end of this study. Interventions: Administration of 100 mg/kg bovine surfactant intratracheally under continuous ventilation and PEEP, as soon as the PaO2/FIO2 ratio dropped to less than 100 for 2 h (in the pilot study increments of 50 mg/kg as long as the PaO2/FIO2 did not increase by 20%). A second equivalent dose within 48 h was permitted. Results: In the pilot study the PaO2/FIO2 increased by a mean of 100 at 48 h (n=19). A higher PaO2/FIO2 ratio was observed in the surfactant group 2 h after the first dose (58 from baseline vs. 9), at 48 h there was a trend towards a higher ratio (38 from baseline vs. 22). The rate of rescue therapy was significantly lower in the surfactant group. Outcome criteria were not affected by a second surfactant dose (n=11). A significant difference in PaO2/FIO2 in favor of surfactant at 48 h was found in the subgroup with an initial PaO2/FIO2 ratio higher than 65 and in patients without pneumonia. Conclusions: Surfactant therapy in severe ARDS improves oxygenation immediately after administration. This improvement is sustained only in the subgroup of patients without pneumonia and that with an initial PaO2/FIO2 ratio higher than 65.

Original languageEnglish
JournalIntensive Care Medicine
Issue number3
Pages (from-to)437-446
Number of pages10
Publication statusPublished - 01.03.2003

Research Areas and Centers

  • Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)


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