SEARCH STRATEGY AND OUTCOME Secondary source—Cochrane Database of Systematic Review,

Should critically ill children with acute respiratory failure be treated with surfactant? SCENARIO A 9-year-old child with relapsed acute lymphoblastic leukae-mia postbone marrow transplant was admitted to the chil-dren’s intensive care unit (ICU) for non-neutropenic fever with worsening respiratory distress that required mechanical ventilation. Despite broad-spectrum antimicrobials, serial chest radiographs showed worsening bilateral infiltrates and increasing mechanical ventilatory requirements. As the regis-trar in the unit, you wondered if intratracheal surfactant would be beneficial in treating this child with acute respira-tory failure. STRUCTURED CLINICAL QUESTION In critically ill children with acute respiratory failure (patient), does treatment with surfactant (intervention) improve gaseous exchange and shorten duration of mechanical ventilation and length of ICU stay (outcomes)