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Meta-Analysis
. 2019 Jan 9;19(1):9.
doi: 10.1186/s12890-018-0761-y.

Effect of Surfactant Administration on Outcomes of Adult Patients in Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials

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Free PMC article
Meta-Analysis

Effect of Surfactant Administration on Outcomes of Adult Patients in Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials

Shan-Shan Meng et al. BMC Pulm Med. .
Free PMC article

Abstract

Introduction: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

Keywords: Acute respiratory distress syndrome; Adult; Mortality; Oxygenation; PaO2/FiO2; Surfactant administration.

Conflict of interest statement

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Not applicable.

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Not applicable.

Competing interests

The author declares that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of the study selection
Fig. 2
Fig. 2
Trial sequential analysis for outcomes in adult ARDS patients after surfactant therapy. a mortality of ARDS. b value of PaO2/FiO2(Fig. 2b)
Fig. 3
Fig. 3
Forest plots of subgroup analyses on the effect of surfactant based on mortality. CI Confidence interval, M-H Mantel-Haenszel
Fig. 4
Fig. 4
Forest plots of analyses on the effect of surfactant based on 28–30-day mortality(APACHE II > 15). CI Confidence interval, M-H Mantel-Haenszel
Fig. 5
Fig. 5
Forest plots of the effect of surfactant based on PaO2/FiO2. CI Confidence interval, M-H Mantel-Haenszel
Fig. 6
Fig. 6
Risk bias analysis for enrolled studies. a Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies. b Risk of bias summary: review authors’ judgments about each risk of bias item for each included study

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References

    1. Sweeney RM, McAuley DF. Acute respiratory distress syndrome. Lancet. 2016;388:2416–2430. doi: 10.1016/S0140-6736(16)00578-X. - DOI - PMC - PubMed
    1. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed
    1. Gille C, Spring B, Bernhard W, Gebhard C, Basile D, Lauber K, et al. Differential effect of surfactant and its saturated phosphatidylcholines on human blood macrophages. J Lipid Res. 2007;48:307–317. doi: 10.1194/jlr.M600451-JLR200. - DOI - PubMed
    1. Clark HW. Untapped therapeutic potential of surfactant proteins: is there a case for recombinant SP-D supplementation in neonatal lung disease? Neonatology. 2010;97:380–387. doi: 10.1159/000297770. - DOI - PubMed
    1. Halliday HL. Recent clinical trials of surfactant treatment for neonates. Biol Neonate. 2006;89:323–329. doi: 10.1159/000092869. - DOI - PubMed

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