World Journal of
Pharmaceutical and Life Sciences

EXOGENOUS SURFACTANT USE IN ACUTE LUNG INJURY AND ARDS; MORE CLEAR OR CLOUDIER-AN UPDATED META-ANALYSIS

*Mohammed Naeem, MD, FAAP, FCCP Muhannad Abu-Abthan Jude Almasoud Hala Alkwai Yasser Kazzaz, FRCPC and Mazen Ferwana, MD Phd

ABSTRACT

Objectives: Surfactant role in the management of pediatric ALI and ARDS is still unclear despite numerous clinical trials (CTs). This meta-analysis aims to analyze randomized and quasi randomized clinical trials in DerSimonian-Laird (Random-effect) model to ascertain the role of surfactant therapy. Data Sources: We searched PubMed, CINAHL, Cochrane, EMBASE, citations and conference proceedings (1980 to August 2018) plus manual search. Study Selection: We identified and extracted randomized controlled trials that evaluated intervention treatment effects of exogenous surfactant in ALI/ ARDS in pediatric age group and analyzed various outcomes including duration of mechanical ventilation, length of stay (LOS) in PICU and mortality. Inclusion criteria for studies was: Randomized and quasi randomized human clinical trials related to pediatric population who had ALI/ ARDS. We excluded neonatal trials and patients with congenital heart diseases. Data Extraction: We screened 1248 citations. 13 full-text articles were retrieved. After exclusion of three RCTs ( 2 no controls and I predominantly adult), ten studies included in meta-analysis. Three investigators (MA, JM, HA) independently extracted data. Ambiguities were resolved through discussions and amendments were done consulting third investigator (MN) when required. Data collected from each study included setting, patient demographics, surfactant characteristics and patient primary and secondary diagnoses. Duration of mechanical ventilation, the primary outcome, was defined as the total number of days the patient had been breathing via endo-tracheal tube and mechanical ventilator and calculated from day 1 of intubation to the day of successful extubation. Data Synthesis: Total ten Studies (N= Total 637, Intervention 322, Control 315) were included in the meta-analysis. Three clinical trials that enrolled 82 subjects provided detailed information about our primary outcome of duration of mechanical ventilation. Pooled data from these trials showed a statistically significant decrease in total duration of mechanical ventilation (Weighted Mean Difference -5.44 days, 95%CI -7.57 to -3.31, p < 0.00001). Regarding duration of hospital stay this study shows a statistically significant difference between the groups (WMD -3.57 days, 95% CI -6.21 to -0.92, P<0.008). The decrease LOS-PICU and increase in adverse effects was not significant. Conclusion: Exogenous surfactant administration in ALI/ ARDS decreases the total duration of mechanical ventilation and length of hospital stay. Mortality outcome could not be analyzed in context of multi-organ dysfunction/ failure. Further scientific evidence in future trials required for this promising intervention in appropriately qualified patients. Abbreviations. PICU; Pediatric Intensive Care Unit, ALI; Acute lung injury, CT; Clinical Trials, RCT; Randomized Clinical Trial, ARDS; Acute respiratory Distress Syndrome, PARDS; Pediatric Acute Respiratory Distress Syndrome, MOD; Multi organ dysfunction, MOF; Multi-organ failure.

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