Efficacy of exogenous surfactant in adult patients with acute respiratory failure

Introduction

Acute respiratory failure and ARDS remains an important cause of mortality and morbidity in patients admitted to the ICU. Several trials were conducted to improve the survival in patients with respiratory failure. The efficacy and safety of the use of surfactant in improving the outcomes of patients with ARDS was recently evaluated in several trials.

Objective

This review is primarily aimed at assessing the efficacy of surfactant in improving the survival of adult patients with acute severe respiratory failure.

Search strategy

The following databases were searched for reports of trials: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4), MEDLINE (1966-November 2005), and EMBASE (1980-November 2005). In addition, bibliographies of review articles and potentially included studies were also searched.

Selection criteria

Prospective randomized controlled trials comparing surfactant treatment with the standard care (or placebo and standard care) in managing adult patients with acute respiratory failure requiring intubation and mechanical ventilation were included.

Data collection and analysis

Data regarding clinical outcomes including the survival at 28 days, the duration of mechanical ventilation, the duration of ICU and hospital stay, and adverse effects. The data on the methodological quality (allocation concealment, intention to treat analysis and Jadad score) of the trials were collected using a standardized data extraction form. Wherever the data were adequate, the outcomes of interest were quantitatively pooled using a random effects model.

Main results

Out of the 16 potentially eligible studies, five trials randomising a total of 1315 patients were included in the analysis. Three of these trials were pilot trials conducted to assess the safety (and efficacy) of surfactant. The other two were large trials conducted to evaluate the efficacy of surfactant. The pooled data on mortality suggested no significant effect of surfactant in reducing the mortality (odds ratio = 1.01; 95% CI = 0.81–1.26: P = 0.9). The data on other outcomes such as the duration of ventilation, ICU and hospital stay, and adverse events were not suitable for performing a meta analysis. The two large trials have both shown an increased incidence of adverse effects in patients where surfactant was used.

Conclusion

The use of surfactant is not associated with an improvement in survival in adult patients with severe respiratory failure.