Effect of surfactant administration on outcomes of adult patients in acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.
Reads0
Chats0
TLDR
Surfactant administration has not been shown to improve mortality and improve oxygenation for adult ARDS patients and Grading of Recommendations Assessment, Development, and Evaluation methodology indicated lack of firm evidence for a beneficial effect.Abstract:
Surfactant is usually deficiency in adult acute respiratory distress syndrome(ARDS) patients and surfactant administration may be a useful therapy. The aim of this study was to perform a meta-analysis of the effect of surfactant administration on outcomes of adult patients with acute respiratory distress syndrome. PubMed, EMBASE, Medline, Cochrane database, Elsevier, Web of Science and http://clinicaltrials.gov
were searched and investigated until December 2017. Randomized controlled trials(RCTs) comparing surfactant administration with general therapy in adult patients with ARDS were enrolled. The primary outcome was mortality (7–10-day, 28–30-day and 90–180-day). Secondary outcome included oxygenation (PaO2/FiO2 ratio). Demographic variables, surfactant administration, and outcomes were retrieved. Sensitivity analyses were used to evaluate the impact of study quality issues on the overall effect. Funnel plot inspection, Egger’s and Begger’s test were applied to investigate the publication bias. Internal validity was assessed with the risk of bias tool. Random errors were evaluated with trial sequential analysis(TSA). Quality levels were assessed by Grading of Recommendations Assessment, Development, and Evaluation methodology(GRADE). Eleven RCTs with 3038 patients were identified. Surfactant administration could not improve mortality of adult patients [Risk ratio (RR) (95%CI)) = 1.02(0.93–1.12), p = 0.65]. Subgroup analysis revealed no difference of 7–10-day mortality [RR(95%CI)) = 0.89(0.54–1.49), p = 0.66], 28–30-day mortality[RR(95%CI) = 1.00(0.89–1.12), p = 0.98] and 90–180-day mortality [RR(95%CI) = 1.11(0.94–1.32), p = 0.22] between surfactant group and control group. The change of the PaO2/FiO2 ratio in adult ARDS patients had no difference [MD(95%CI) = 0.06(− 0.12–0.24), p = 0.5] after surfactant administration. Finally, TSA and GRADE indicated lack of firm evidence for a beneficial effect. Surfactant administration has not been shown to improve mortality and improve oxygenation for adult ARDS patients. Large rigorous randomized trials are needed to explore the effect of surfactant to adult ARDS patients.read more
Citations
More filters
Journal ArticleDOI
Surfactant therapy for COVID-19 related ARDS: a retrospective case-control pilot study.
Simone Piva,Robert M DiBlasi,Robert M DiBlasi,April Slee,Alan H. Jobe,Alan H. Jobe,Alan H. Jobe,Aldo M. Roccaro,Matteo Filippini,Nicola Latronico,Michele Bertoni,John C. Marshall,Michael A. Portman,Michael A. Portman +13 more
TL;DR: The feasibility and safety of surfactant delivery in COVID-19 ARDS patients have not been established as mentioned in this paper, however, the authors performed a retrospective analysis of data from patients receiving off-label use of exogenous natural surfactants during the COVID19 pandemic.
Journal ArticleDOI
Personalized pharmacological therapy for ARDS: a light at the end of the tunnel.
TL;DR: Individualized medicine targeting the different ARDS phenotypes has emerged as an option to improve survival and Identification of specific ARDS patient phenotypes that respond to specific therapies seems to be the most important challenge for the next decade.
Journal ArticleDOI
Pharmacological management of COVID-19 patients with ARDS (CARDS): A narrative review.
TL;DR: This narrative review, based on a selective literature search in EMBASE, MEDLINE, Scopus, The Cochrane Library, Web of Science, and Google Scholar and ClinicalTrials.gov, has examined the emerging evidence on the possible treatment of CARDS.
Journal ArticleDOI
The Role of Pulmonary Surfactants in the Treatment of Acute Respiratory Distress Syndrome in COVID-19
TL;DR: In this article, the authors investigated the role of pulmonary surfactant (PS) in lung homeostasis and infection in severe acute respiratory syndrome coronavirus disease -2019 (COVID-19).
Journal ArticleDOI
Surfactant replacement might help recovery of low-compliance lung in severe COVID-19 pneumonia.
Stefano Busani,Lorenzo Dall’Ara,Roberto Tonelli,Enrico Clini,Elena Munari,Sophie Venturelli,Marianna Meschiari,Giovanni Guaraldi,Andrea Cossarizza,V. Marco Ranieri,Massimo Girardis +10 more
TL;DR: The reviews of this paper are available via the supplemental material section.
References
More filters
Journal ArticleDOI
Measuring inconsistency in meta-analyses
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Journal ArticleDOI
Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries
Giacomo Bellani,John G. Laffey,John G. Laffey,Tài Pham,Tài Pham,Eddy Fan,Eddy Fan,Laurent Brochard,Laurent Brochard,Andrés Esteban,Luciano Gattinoni,Frank van Haren,Anders Larsson,Daniel F. McAuley,Marco Ranieri,Gordon D. Rubenfeld,Gordon D. Rubenfeld,B. Taylor Thompson,Hermann Wrigge,Arthur S. Slutsky,Antonio Pesenti +20 more
TL;DR: Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning, which indicates the potential for improvement in the management of patients with ARDS.
Journal ArticleDOI
Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis.
TL;DR: TSA may establish when firm evidence is reached in meta-analysis, and six randomly selected neonatal meta-analyses showed early potentially spurious P<0.05 values, establishing firm evidence of an intervention effect.
Journal ArticleDOI
Apparently conclusive meta-analyses may be inconclusive—Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses
TL;DR: A trial sequential analysis (TSA) may reduce risk of random errors due to repetitive testing of accumulating data by evaluating meta-analyses not reaching the information size with monitoring boundaries, analogous to sequential monitoring boundaries in a single trial.
Journal ArticleDOI
Aerosolized Surfactant in Adults with Sepsis-Induced Acute Respiratory Distress Syndrome
Antonio Anzueto,Robert P. Baughman,Kalpalatha K. Guntupalli,John G. Weg,Herbert P. Wiedemann,Antoni Artigas Raventós,François Lemaire,Walker Long,David Zaccardelli,Edward N. Pattishall +9 more
TL;DR: The continuous administration of aerosolized synthetic surfactant to patients with sepsis-induced ARDS had no significant effect on 30-day survival, length of stay in the intensive care unit, duration of mechanical ventilation, or physiologic function.