We appreciate Drs Barbi, Faleschini, and Bassanese raising the issue of treatment of children with severe bronchiolitis and the possible role of surfactant therapy. Our article1 was based on a comprehensive systematic review of the diagnosis and treatment of bronchiolitis in infants and children. The full report is available elsewhere, as detailed in our article; however, in the February 2004 issue of the ARCHIVES, only detailed results for the most commonly used pharmacologic agents are presented, and we specifically excluded surfactant and other less common interventions. Our complete review identified 1 randomized controlled trial of surfactant therapy that met our inclusion criteria.2 Luchetti et al2 conducted a small study of 20 infants with severe bronchiolitis. The treatment group received 50 mg/kg of porcine-derived surfactant instilled into the trachea in 2 to 3 doses. Both the control and treatment groups received continuous positive pressure ventilation and other supportive treatments. They found that the mean durations of intensive care unit stay and of ventilation were shorter in the treatment group. We rated the quality of this study as only fair because of the following 4 methodological shortcomings: (1) small sample size; (2) masking of investigators was not described; (3) it was not clear that the control group had been sedated and paralyzed as the treatment group had been; and (4) the control group did not appear to have been given a placebo such as the surfactant vehicle solution to assure appropriate study masking.
King VJ, Bordley WC, Viswanathan M. Do We Really Need More Trials About the Efficacy of Commonly Used Treatments for Bronchiolitis?—Reply. Arch Pediatr Adolesc Med. 2005;159(2):195–197. doi:10.1001/archpedi.159.2.197-a