0
Original Research: CRITICAL CARE MEDICINE |

A Search for Subgroups of Patients With ARDS Who May Benefit From Surfactant Replacement Therapy: A Pooled Analysis of Five Studies With Recombinant Surfactant Protein-C Surfactant (Venticute)

Friedemann J. H. Taut, MD; Gerd Rippin, PhD; Peter Schenk, MD; George Findlay, MD; Wilhelm Wurst, MD; Dietrich Häfner, MD; James F. Lewis, MD; Werner Seeger, MD; Andreas Günther, MD; Roger G. Spragg, MD
Author and Funding Information

*From the Department of Clinical Research (Drs. Taut, Wurst, and Häfner), Nycomed, Konstanz, Germany; the Department of Biometrics (Dr. Rippin), Omnicare Clinical Research, Cologne, Germany; the Department of Internal Medicine IV (Dr. Schenk), General Hospital Vienna, Vienna, Austria; the Department of Intensive Care (Dr. Findlay), University Hospital of Wales, Cardiff, UK; St. Joseph's Health Center (Dr. Lewis), University of Western Ontario, London, ON, Canada; the Department of Pulmonology (Drs. Seeger and Günther), Justus-Liebig University, Giessen, Germany; and the Division of Pulmonary and Critical Care Medicine (Dr. Spragg), University of California San Diego and the San Diego VA Healthcare System, La Jolla, CA. Nycomed GmbH (formerly Altana Pharma GmbH), Konstanz, Germany was the sponsor of the clinical studies and supplied the study medication.

Correspondence to: Roger G. Spragg, MD, VA Medical Center, 151A, 3350 La Jolla Village Dr, San Diego, CA, 92161; e-mail: rspragg@ucsd.edu

Drs. Taut, Wurst, and Ḧafner are current or former employees of Nycomed. Drs. Rippin, Schenk, Findlay, Lewis, Seeger, Guenther, and Spragg have contractual relationships with Nycomed.


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(4):724-732. doi:10.1378/chest.08-0362
Text Size: A A A
Published online

Background:  Studies to date have shown no survival benefit for the use of exogenous surfactant to treat patients with the ARDS. To identify specific patient subgroups for future study, we performed an exploratory post hoc analysis of clinical trials of recombinant surfactant protein-C (rSP-C) surfactant (Venticute; Nycomed GmbH; Konstanz, Germany).

Methods:  We performed a pooled analysis of all five multicenter studies in which patients with ARDS due to various predisposing events were treated with rSP-C surfactant. Patients received either usual care (n = 266) or usual care plus up to four intratracheal doses (50 mg/kg) of rSP-C surfactant (n = 266). Factors influencing the study end points were analyzed using descriptive statistics, analysis of covariance, and logistic regression models.

Results:  ARDS was most often associated with pneumonia or aspiration, sepsis, and trauma or surgery. For the overall patient population, treatment with rSP-C surfactant significantly improved oxygenation (p = 0.002) but had no effect on mortality (32.6%). Multivariate analysis showed age and acute physiology and chronic health evaluation (APACHE) II score to be the strongest predictors of mortality. In the subgroup of patients with severe ARDS due to pneumonia or aspiration, surfactant treatment was associated with markedly improved oxygenation (p = 0.0008) and improved survival (p = 0.018).

Conclusions:  rSP-C surfactant improved oxygenation in patients with ARDS irrespective of the predisposition. Post hoc evidence of reduced mortality associated with surfactant treatment was obtained in patients with severe respiratory insufficiency due to pneumonia or aspiration. Those patients are the focus of a current randomized, blinded, clinical trial with rSP-C surfactant.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543