Surfactant therapy for bronchiolitis in critically ill infants

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Background - Viral bronchiolitis is a common cause of respiratory failure in children. About 10 to 15% of previously healthy children are likely to be admitted to an intensive care unit (ICU) if they become hospitalised by bronchiolitis, and about half of these children will need mechanical ventilation. Children with pre-existing conditions, such as congenital heart disease, chronic lung disease and children who are immunocompromised are at a much greater risk of developing bronchiolitis.

The viruses that cause bronchiolitis cause the small airways in the child’s lungs to be obstructed, this causes them to cough and wheeze. Bronchiolitis has no definitive treatment. Although many different therapies for bronchiolitis have been identified and studied, there isn’t currently enough evidence to support the use of any of them and children with bronchiolitis are often only given supportive care.

Surfactant is a substance made up of proteins and lipids that is required for normal functioning of lungs. Severe bronchiolitis may also cause children to become deficient in surfactant. Surfactant has been suggested as a possible therapy for bronchiolitis as it is able to make the alveoli more stable and helps to improve mechanical properties of lungs. Therefore it has been suggested that administering surfactant into the lower airways might help children who develop severe bronchiolitis to recover from the disease more quickly.

Objective/s (information similar to Review Question) - To determine the efficacy of surfactant for the treatment of acute bronchiolitis in mechanically ventilated children when compared to placebo, no intervention or standard care

Intervention/Methods (information similar to Study Characteristics) - The authors searched for trials that looked at the outcomes of children who had been given surfactant after a diagnosis of acute viral bronchiolitis that required them to be intubated and mechanically ventilated. They included both children who had been previously healthy and those who were at high risk (i.e. those with congenital heart disease, chronic lung disease etc.) They included all randomised controlled studies, including both those that did and those that did not use a placebo control.

The main outcomes they looked at were: mortality, duration of mechanical ventilation, duration of ICU stay and reported adverse effects.

Results - Three trials were included in the review, giving a total of 79 patients (39 received surfactant and 40 were controls). One study used a placebo control.
Original languageEnglish
Pages (from-to)84-85
JournalClinical Nurse Specialist
Issue number2
Publication statusPublished - 1 Mar 2016


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