Exogenous surfactant administration is currently being tested in patients with the acute respiratory distress syndrome (ARDS). The results of the studies have varied because several factors may influence the host’s response to this therapy. This clinical pilot study was designed to evaluate the safety and efficacy of exogenous surfactant administration in pediatric patients with ARDS. Surfactant was administered to 13 patients with severe lung dysfunction, and eight of these patients experienced a significant improvement in oxygenation after the first dose of surfactant. In these patients the exogenous surfactant was administered within 48 h of the diagnosis of ARDS, whereas in the five patients who did not respond, surfactant was administered several days after the onset of ARDS. Responders also spent fewer days on a mechanical ventilator and less time in intensive care compared with nonresponders. Based on the results of this pilot study, a more appropriate multicentre clinical trial should be designed to evaluate this treatment strategy.

OBJECTIVESTo study the acute hemodynamic effects of furosemide in critically ill pediatrics patients, the temporal relationship between hemodynamic changes and changes in neuroendocrine axis, and the temporal relationship between hemodynamic changes and urine output.DESIGNProspective study.SETTINGPediatric intensive care unit in a tertiary care university center.PATIENTSFourteen critically ill pediatric patients who clinically required diuretic therapy.INTERVENTIONSBefore and after furosemide administration, hemodynamic and neurohormonal measurements were taken.MEASUREMENTS AND MAIN RESULTSHemodynamic and neurohormonal responses to acute diuretic therapy were measured in 14 pediatric patients treated with furosemide (1 mg/kg/dose). Cardiac index deteriorated by 10 mins after drug administration (-9.4+/-3.9%, p<.05) and was associated with an increase in systemic vascular resistance (17.1+/-4.8%, p<.05). There was a subsequent increase in cardiac index (20+/-4.9%, p<.05) at 30 mins, with a decrease in systemic vascular resistance (-11.5+/-5.2%, p<.05). These hemodynamic changes were associated with marked increases in renin and norepinephrine concentrations and an increase in urinary prostaglandin release. The hemodynamic and neurohormonal effects had their onset before maximum diuresis.CONCLUSIONIntravenous furosemide administration in acutely ill pediatric patients results in an acute but transient deterioration in cardiac function that appears to parallel the neuroendocrine changes rather than the acute diuresis.

Singh, Narendra C.; Johnson, Craig; Frewen, Timothy; Kronick, Jonathan Author Information

Dhillon, Jasvinder S.; Singh, Narendra C.; Johnson, Craig C.; Burke-Tremblay, Catherine; Dvali, Linda; Kronick, Jonathan B. Author Information

Singh, Narendra C.; Yetman, Anji T.; Parbtani, Anwar; Loft, Jacquie A.; Linley, Mary Ann; Johnson, Craig C. Author Information