Adult ARDS: surfactant does not cut mortality, per meta-analysis

  • Meng SS & al.
  • BMC Pulm Med
  • 9 Jan 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For adults with acute respiratory distress syndrome (ARDS), surfactant treatment does not reduce mortality or improve oxygenation, according to the results of this meta-analysis.

Why this matters

  • ARDS often features deficient surfactant.
  • Adult trials of surfactant administration have yielded mixed results.
  • ARDS mortality reaches as high as 46%.

Key results

  • Mortality with surfactant vs without: risk ratio, 1.02 (95% CI, 0.93-1.12; P=.65).
  • Mortality showed no significant between-group differences whether measured at 7-10,  28-30, or 90-180 days. 
  • PaO2/FiO2 ratio with surfactant vs without: mean difference, 0.06 (95% CI, −0.12 to 0.24; P=.5).
  • No publication bias detected. 

Study design

  • Meta-analysis of 11 randomized controlled trials that compared pulmonary surfactant vs standard therapy in adults with ARDS (n=3038).  
  • Outcome: mortality.
  • Funding: Chinese national and provincial funds.

Limitations

  • Small sample sizes.
  • Some bias risks.
  • Surfactants and treatment duration differed among trials.