The Experts below are selected from a list of 96 Experts worldwide ranked by ideXlab platform
Douglas F Willson - One of the best experts on this subject based on the ideXlab platform.
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the adult Calfactant in acute respiratory distress syndrome trial
Chest, 2015Co-Authors: Douglas F Willson, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edmund E EganAbstract:BACKGROUND Surfactant has been shown to be dysfunctional in ARDS, and exogenous surfactant has proven effective in many forms of neonatal and pediatric acute lung injury (ALI). In view of the positive results of our studies in children along with evidence that surfactant-associated protein B containing pharmaceutical surfactants might be more effective, we designed a multiinstitutional, randomized, controlled, and masked trial of Calfactant, a calf lung surfactant, in adults and children with ALI/ARDS due to direct lung injury. METHODS Adult subjects within 48 h of initiation of mechanical ventilation for direct ARDS were randomized to receive up to three interventions with instilled Calfactant vs air placebo. The primary outcome was 90-day all-cause mortality. RESULTS Three hundred seventeen subjects were enrolled, 308 of whom could be evaluated. There were no significant baseline differences between groups. Calfactant administration was not associated with improved survival, lengths of stay, or oxygenation. Calfactant instillation was frequently associated with transient hypoxia and hypotension. The study was stopped at the first interim analysis at the sponsor's request. CONCLUSIONS Administration of Calfactant was not associated with improved oxygenation or longer-term benefits relative to placebo in this randomized, controlled, and masked trial. At present, exogenous surfactant cannot be recommended for routine clinical use in ARDS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00682500; URL: www.clinicaltrials.gov.
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pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Rationale Our previous studies in children with acute lung injury/acute respiratory distress syndrome demonstrated improved outcomes with exogenous surfactant (Calfactant) administration. Sample sizes in those studies were small, however, and the subject populations heterogeneous, thus making recommendations tenuous. Objective To investigate the efficacy of surfactant administration in a larger, more homogenous population of children with lung injury/acute respiratory distress syndrome due to direct lung injury. Design and setting Masked, randomized, placebo-controlled trial in 24 children's hospitals in six different countries. Patients and methods Children 37 weeks postconception to 18 years old with lung injury/acute respiratory distress syndrome due to direct lung injury were randomized to receive up to three doses of 30 mg/cm height of surfactant (Calfactant) versus placebo (air) within 48 hours of intubation and initiation of mechanical ventilation. The primary outcome was mortality at 90 days. Ventilator-free days, changes in oxygenation, and adverse events were also assessed. Results The study was stopped at the sponsor's request after the second interim analysis for presumed futility. A total of 110 subjects were enrolled, with consent withdrawn from one whose data are unavailable. There were no significant differences between groups except in hospital-free days (10.4 ± 7.8 placebo vs 6.4 ± 7.8 surfactant; p = 0.01). Overall 90-day mortality was 11% (seven surfactant, five placebo). No immediate improvement in oxygenation was associated with surfactant administration. Conclusions Surfactant did not improve outcomes relative to placebo in this trial of children with direct lung injury/acute respiratory distress syndrome. Differences in concentration of the surfactant, failure to recruit the lung during surfactant administration, or using two rather than four position changes during administration are possible explanations for the difference from previous studies. Exogenous surfactant cannot be recommended at this time for children with direct lung injury/acute respiratory distress syndrome.
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the relationship of fluid administration to outcome in the pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Objectives:Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute respiratory distress syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute respiratory distress syndrome and its effect on outcome
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post hoc analysis of Calfactant use in immunocompromised children with acute lung injury impact and feasibility of further clinical trials
Pediatric Critical Care Medicine, 2008Co-Authors: Robert F Tamburro, Neal J Thomas, Steven Pon, Brian R Jacobs, Joseph V Dicarlo, Barry P Markovitz, Larry S Jefferson, Douglas F WillsonAbstract:Objective:To assess the impact of Calfactant (a modified natural bovine lung surfactant) in immunocompromised children with acute lung injury and to determine the number of patients required for a definitive clinical trial of Calfactant in this population.Design:Post hoc analysis of data from a prev
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effect of exogenous surfactant Calfactant in pediatric acute lung injury a randomized controlled trial
JAMA, 2005Co-Authors: Douglas F Willson, Neal J Thomas, Brian R Jacobs, Joseph V Dicarlo, Barry P Markovitz, Larry S Jefferson, Mark R Conaway, Loren A Bauman, Edward A EganAbstract:ContextDespite evidence that patients with acute lung injury (ALI) have pulmonary surfactant dysfunction, trials of several surfactant preparations to treat adults with ALI have not been successful. Preliminary studies in children with ALI have shown that instillation of a natural lung surfactant (Calfactant) containing high levels of surfactant-specific protein B may be beneficial.ObjectiveTo determine if endotracheal instillation of Calfactant in infants, children, and adolescents with ALI would shorten the course of respiratory failure.Design, Setting, and PatientsA multicenter, randomized, blinded trial of Calfactant compared with placebo in 153 infants, children, and adolescents with respiratory failure from ALI conducted from July 2000 to July 2003. Twenty-one tertiary care pediatric intensive care units participated. Entry criteria included age 1 week to 21 years, enrollment within 48 hours of endotracheal intubation, radiological evidence of bilateral lung disease, and an oxygenation index higher than 7. Premature infants and children with preexisting lung, cardiac, or central nervous system disease were excluded.InterventionTreatment with intratracheal instillation of 2 doses of 80 mL/m2 Calfactant or an equal volume of air placebo administered 12 hours apart.Main Outcome MeasuresVentilator-free days and mortality; secondary outcome measures were hospital course, adverse events, and failure of conventional mechanical ventilation.ResultsThe Calfactant group experienced an acute mean (SD) decrease in oxygenation index from 20 (12.9) to 13.9 (9.6) after 12 hours compared with the placebo group’s decrease from 20.5 (14.7) to 15.1 (9.0) (P = .01). Mortality was significantly greater in the placebo group compared with the Calfactant group (27/75 vs 15/77; odds ratio, 2.32; 95% confidence interval, 1.15-4.85), although ventilator-free days were not different. More patients in the placebo group did not respond to conventional mechanical ventilation. There were no differences in long-term complications.ConclusionsCalfactant acutely improved oxygenation and significantly decreased mortality in infants, children, and adolescents with ALI although no significant decrease in the course of respiratory failure measured by duration of ventilator therapy, intensive care unit, or hospital stay was observed.
Edmund E Egan - One of the best experts on this subject based on the ideXlab platform.
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the adult Calfactant in acute respiratory distress syndrome trial
Chest, 2015Co-Authors: Douglas F Willson, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edmund E EganAbstract:BACKGROUND Surfactant has been shown to be dysfunctional in ARDS, and exogenous surfactant has proven effective in many forms of neonatal and pediatric acute lung injury (ALI). In view of the positive results of our studies in children along with evidence that surfactant-associated protein B containing pharmaceutical surfactants might be more effective, we designed a multiinstitutional, randomized, controlled, and masked trial of Calfactant, a calf lung surfactant, in adults and children with ALI/ARDS due to direct lung injury. METHODS Adult subjects within 48 h of initiation of mechanical ventilation for direct ARDS were randomized to receive up to three interventions with instilled Calfactant vs air placebo. The primary outcome was 90-day all-cause mortality. RESULTS Three hundred seventeen subjects were enrolled, 308 of whom could be evaluated. There were no significant baseline differences between groups. Calfactant administration was not associated with improved survival, lengths of stay, or oxygenation. Calfactant instillation was frequently associated with transient hypoxia and hypotension. The study was stopped at the first interim analysis at the sponsor's request. CONCLUSIONS Administration of Calfactant was not associated with improved oxygenation or longer-term benefits relative to placebo in this randomized, controlled, and masked trial. At present, exogenous surfactant cannot be recommended for routine clinical use in ARDS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00682500; URL: www.clinicaltrials.gov.
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pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Rationale Our previous studies in children with acute lung injury/acute respiratory distress syndrome demonstrated improved outcomes with exogenous surfactant (Calfactant) administration. Sample sizes in those studies were small, however, and the subject populations heterogeneous, thus making recommendations tenuous. Objective To investigate the efficacy of surfactant administration in a larger, more homogenous population of children with lung injury/acute respiratory distress syndrome due to direct lung injury. Design and setting Masked, randomized, placebo-controlled trial in 24 children's hospitals in six different countries. Patients and methods Children 37 weeks postconception to 18 years old with lung injury/acute respiratory distress syndrome due to direct lung injury were randomized to receive up to three doses of 30 mg/cm height of surfactant (Calfactant) versus placebo (air) within 48 hours of intubation and initiation of mechanical ventilation. The primary outcome was mortality at 90 days. Ventilator-free days, changes in oxygenation, and adverse events were also assessed. Results The study was stopped at the sponsor's request after the second interim analysis for presumed futility. A total of 110 subjects were enrolled, with consent withdrawn from one whose data are unavailable. There were no significant differences between groups except in hospital-free days (10.4 ± 7.8 placebo vs 6.4 ± 7.8 surfactant; p = 0.01). Overall 90-day mortality was 11% (seven surfactant, five placebo). No immediate improvement in oxygenation was associated with surfactant administration. Conclusions Surfactant did not improve outcomes relative to placebo in this trial of children with direct lung injury/acute respiratory distress syndrome. Differences in concentration of the surfactant, failure to recruit the lung during surfactant administration, or using two rather than four position changes during administration are possible explanations for the difference from previous studies. Exogenous surfactant cannot be recommended at this time for children with direct lung injury/acute respiratory distress syndrome.
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the relationship of fluid administration to outcome in the pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Objectives:Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute respiratory distress syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute respiratory distress syndrome and its effect on outcome
Robert F Tamburro - One of the best experts on this subject based on the ideXlab platform.
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calipso a randomized controlled trial of Calfactant for acute lung injury in pediatric stem cell and oncology patients
Biology of Blood and Marrow Transplantation, 2018Co-Authors: Neal J Thomas, Steven Pon, Barry P Markovitz, Debbie Spear, Emily Wasserman, Aalok R Singh, Shira Gertz, Courtney M Rowan, Allen R Kunselman, Robert F TamburroAbstract:Abstract To assess if Calfactant reduces mortality among children with leukemia/lymphoma or after hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS), we conducted a multicenter, randomized, placebo-controlled, double-blinded trial in 17 pediatric intensive care units (PICUs) of tertiary care children's hospitals. Patients ages 18 months to 25 years with leukemia/lymphoma or having undergone HCT who required invasive mechanical ventilation for bilateral lung disease with an oxygenation index (OI) > 10 and
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pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Rationale Our previous studies in children with acute lung injury/acute respiratory distress syndrome demonstrated improved outcomes with exogenous surfactant (Calfactant) administration. Sample sizes in those studies were small, however, and the subject populations heterogeneous, thus making recommendations tenuous. Objective To investigate the efficacy of surfactant administration in a larger, more homogenous population of children with lung injury/acute respiratory distress syndrome due to direct lung injury. Design and setting Masked, randomized, placebo-controlled trial in 24 children's hospitals in six different countries. Patients and methods Children 37 weeks postconception to 18 years old with lung injury/acute respiratory distress syndrome due to direct lung injury were randomized to receive up to three doses of 30 mg/cm height of surfactant (Calfactant) versus placebo (air) within 48 hours of intubation and initiation of mechanical ventilation. The primary outcome was mortality at 90 days. Ventilator-free days, changes in oxygenation, and adverse events were also assessed. Results The study was stopped at the sponsor's request after the second interim analysis for presumed futility. A total of 110 subjects were enrolled, with consent withdrawn from one whose data are unavailable. There were no significant differences between groups except in hospital-free days (10.4 ± 7.8 placebo vs 6.4 ± 7.8 surfactant; p = 0.01). Overall 90-day mortality was 11% (seven surfactant, five placebo). No immediate improvement in oxygenation was associated with surfactant administration. Conclusions Surfactant did not improve outcomes relative to placebo in this trial of children with direct lung injury/acute respiratory distress syndrome. Differences in concentration of the surfactant, failure to recruit the lung during surfactant administration, or using two rather than four position changes during administration are possible explanations for the difference from previous studies. Exogenous surfactant cannot be recommended at this time for children with direct lung injury/acute respiratory distress syndrome.
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the relationship of fluid administration to outcome in the pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Objectives:Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute respiratory distress syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute respiratory distress syndrome and its effect on outcome
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post hoc analysis of Calfactant use in immunocompromised children with acute lung injury impact and feasibility of further clinical trials
Pediatric Critical Care Medicine, 2008Co-Authors: Robert F Tamburro, Neal J Thomas, Steven Pon, Brian R Jacobs, Joseph V Dicarlo, Barry P Markovitz, Larry S Jefferson, Douglas F WillsonAbstract:Objective:To assess the impact of Calfactant (a modified natural bovine lung surfactant) in immunocompromised children with acute lung injury and to determine the number of patients required for a definitive clinical trial of Calfactant in this population.Design:Post hoc analysis of data from a prev
Neal J Thomas - One of the best experts on this subject based on the ideXlab platform.
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calipso a randomized controlled trial of Calfactant for acute lung injury in pediatric stem cell and oncology patients
Biology of Blood and Marrow Transplantation, 2018Co-Authors: Neal J Thomas, Steven Pon, Barry P Markovitz, Debbie Spear, Emily Wasserman, Aalok R Singh, Shira Gertz, Courtney M Rowan, Allen R Kunselman, Robert F TamburroAbstract:Abstract To assess if Calfactant reduces mortality among children with leukemia/lymphoma or after hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS), we conducted a multicenter, randomized, placebo-controlled, double-blinded trial in 17 pediatric intensive care units (PICUs) of tertiary care children's hospitals. Patients ages 18 months to 25 years with leukemia/lymphoma or having undergone HCT who required invasive mechanical ventilation for bilateral lung disease with an oxygenation index (OI) > 10 and
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pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Rationale Our previous studies in children with acute lung injury/acute respiratory distress syndrome demonstrated improved outcomes with exogenous surfactant (Calfactant) administration. Sample sizes in those studies were small, however, and the subject populations heterogeneous, thus making recommendations tenuous. Objective To investigate the efficacy of surfactant administration in a larger, more homogenous population of children with lung injury/acute respiratory distress syndrome due to direct lung injury. Design and setting Masked, randomized, placebo-controlled trial in 24 children's hospitals in six different countries. Patients and methods Children 37 weeks postconception to 18 years old with lung injury/acute respiratory distress syndrome due to direct lung injury were randomized to receive up to three doses of 30 mg/cm height of surfactant (Calfactant) versus placebo (air) within 48 hours of intubation and initiation of mechanical ventilation. The primary outcome was mortality at 90 days. Ventilator-free days, changes in oxygenation, and adverse events were also assessed. Results The study was stopped at the sponsor's request after the second interim analysis for presumed futility. A total of 110 subjects were enrolled, with consent withdrawn from one whose data are unavailable. There were no significant differences between groups except in hospital-free days (10.4 ± 7.8 placebo vs 6.4 ± 7.8 surfactant; p = 0.01). Overall 90-day mortality was 11% (seven surfactant, five placebo). No immediate improvement in oxygenation was associated with surfactant administration. Conclusions Surfactant did not improve outcomes relative to placebo in this trial of children with direct lung injury/acute respiratory distress syndrome. Differences in concentration of the surfactant, failure to recruit the lung during surfactant administration, or using two rather than four position changes during administration are possible explanations for the difference from previous studies. Exogenous surfactant cannot be recommended at this time for children with direct lung injury/acute respiratory distress syndrome.
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the relationship of fluid administration to outcome in the pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Objectives:Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute respiratory distress syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute respiratory distress syndrome and its effect on outcome
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post hoc analysis of Calfactant use in immunocompromised children with acute lung injury impact and feasibility of further clinical trials
Pediatric Critical Care Medicine, 2008Co-Authors: Robert F Tamburro, Neal J Thomas, Steven Pon, Brian R Jacobs, Joseph V Dicarlo, Barry P Markovitz, Larry S Jefferson, Douglas F WillsonAbstract:Objective:To assess the impact of Calfactant (a modified natural bovine lung surfactant) in immunocompromised children with acute lung injury and to determine the number of patients required for a definitive clinical trial of Calfactant in this population.Design:Post hoc analysis of data from a prev
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effect of exogenous surfactant Calfactant in pediatric acute lung injury a randomized controlled trial
JAMA, 2005Co-Authors: Douglas F Willson, Neal J Thomas, Brian R Jacobs, Joseph V Dicarlo, Barry P Markovitz, Larry S Jefferson, Mark R Conaway, Loren A Bauman, Edward A EganAbstract:ContextDespite evidence that patients with acute lung injury (ALI) have pulmonary surfactant dysfunction, trials of several surfactant preparations to treat adults with ALI have not been successful. Preliminary studies in children with ALI have shown that instillation of a natural lung surfactant (Calfactant) containing high levels of surfactant-specific protein B may be beneficial.ObjectiveTo determine if endotracheal instillation of Calfactant in infants, children, and adolescents with ALI would shorten the course of respiratory failure.Design, Setting, and PatientsA multicenter, randomized, blinded trial of Calfactant compared with placebo in 153 infants, children, and adolescents with respiratory failure from ALI conducted from July 2000 to July 2003. Twenty-one tertiary care pediatric intensive care units participated. Entry criteria included age 1 week to 21 years, enrollment within 48 hours of endotracheal intubation, radiological evidence of bilateral lung disease, and an oxygenation index higher than 7. Premature infants and children with preexisting lung, cardiac, or central nervous system disease were excluded.InterventionTreatment with intratracheal instillation of 2 doses of 80 mL/m2 Calfactant or an equal volume of air placebo administered 12 hours apart.Main Outcome MeasuresVentilator-free days and mortality; secondary outcome measures were hospital course, adverse events, and failure of conventional mechanical ventilation.ResultsThe Calfactant group experienced an acute mean (SD) decrease in oxygenation index from 20 (12.9) to 13.9 (9.6) after 12 hours compared with the placebo group’s decrease from 20.5 (14.7) to 15.1 (9.0) (P = .01). Mortality was significantly greater in the placebo group compared with the Calfactant group (27/75 vs 15/77; odds ratio, 2.32; 95% confidence interval, 1.15-4.85), although ventilator-free days were not different. More patients in the placebo group did not respond to conventional mechanical ventilation. There were no differences in long-term complications.ConclusionsCalfactant acutely improved oxygenation and significantly decreased mortality in infants, children, and adolescents with ALI although no significant decrease in the course of respiratory failure measured by duration of ventilator therapy, intensive care unit, or hospital stay was observed.
Christine Traul - One of the best experts on this subject based on the ideXlab platform.
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the adult Calfactant in acute respiratory distress syndrome trial
Chest, 2015Co-Authors: Douglas F Willson, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edmund E EganAbstract:BACKGROUND Surfactant has been shown to be dysfunctional in ARDS, and exogenous surfactant has proven effective in many forms of neonatal and pediatric acute lung injury (ALI). In view of the positive results of our studies in children along with evidence that surfactant-associated protein B containing pharmaceutical surfactants might be more effective, we designed a multiinstitutional, randomized, controlled, and masked trial of Calfactant, a calf lung surfactant, in adults and children with ALI/ARDS due to direct lung injury. METHODS Adult subjects within 48 h of initiation of mechanical ventilation for direct ARDS were randomized to receive up to three interventions with instilled Calfactant vs air placebo. The primary outcome was 90-day all-cause mortality. RESULTS Three hundred seventeen subjects were enrolled, 308 of whom could be evaluated. There were no significant baseline differences between groups. Calfactant administration was not associated with improved survival, lengths of stay, or oxygenation. Calfactant instillation was frequently associated with transient hypoxia and hypotension. The study was stopped at the first interim analysis at the sponsor's request. CONCLUSIONS Administration of Calfactant was not associated with improved oxygenation or longer-term benefits relative to placebo in this randomized, controlled, and masked trial. At present, exogenous surfactant cannot be recommended for routine clinical use in ARDS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00682500; URL: www.clinicaltrials.gov.
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pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Rationale Our previous studies in children with acute lung injury/acute respiratory distress syndrome demonstrated improved outcomes with exogenous surfactant (Calfactant) administration. Sample sizes in those studies were small, however, and the subject populations heterogeneous, thus making recommendations tenuous. Objective To investigate the efficacy of surfactant administration in a larger, more homogenous population of children with lung injury/acute respiratory distress syndrome due to direct lung injury. Design and setting Masked, randomized, placebo-controlled trial in 24 children's hospitals in six different countries. Patients and methods Children 37 weeks postconception to 18 years old with lung injury/acute respiratory distress syndrome due to direct lung injury were randomized to receive up to three doses of 30 mg/cm height of surfactant (Calfactant) versus placebo (air) within 48 hours of intubation and initiation of mechanical ventilation. The primary outcome was mortality at 90 days. Ventilator-free days, changes in oxygenation, and adverse events were also assessed. Results The study was stopped at the sponsor's request after the second interim analysis for presumed futility. A total of 110 subjects were enrolled, with consent withdrawn from one whose data are unavailable. There were no significant differences between groups except in hospital-free days (10.4 ± 7.8 placebo vs 6.4 ± 7.8 surfactant; p = 0.01). Overall 90-day mortality was 11% (seven surfactant, five placebo). No immediate improvement in oxygenation was associated with surfactant administration. Conclusions Surfactant did not improve outcomes relative to placebo in this trial of children with direct lung injury/acute respiratory distress syndrome. Differences in concentration of the surfactant, failure to recruit the lung during surfactant administration, or using two rather than four position changes during administration are possible explanations for the difference from previous studies. Exogenous surfactant cannot be recommended at this time for children with direct lung injury/acute respiratory distress syndrome.
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the relationship of fluid administration to outcome in the pediatric Calfactant in acute respiratory distress syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Neal J Thomas, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Edmund E EganAbstract:Objectives:Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute respiratory distress syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute respiratory distress syndrome and its effect on outcome
