Lancet Respir Med

SCCM 2026: Endotracheal surfactant shows limited benefit in severe infant bronchiolitis

March 27, 2026

In the multicenter, phase 2 BESS trial, 232 mechanically ventilated infants with life‑threatening bronchiolitis were randomized to endotracheal poractant alfa or a sham procedure, with the primary outcome being duration of invasive mechanical ventilation (IMV) from randomization to final successful extubation. Reported at the Society of Critical Care Medicine annual meeting and published in Lancet Respiratory Medicine, surfactant did not reduce ventilation time: median IMV duration was 64.9 hours with surfactant vs 62.0 hours with sham (geometric mean ratio, 1.02; 95% confidence interval, 0.84–1.24; P=0.86). Safety outcomes were similar between groups, with no excess serious adverse events. Investigators noted that while surfactant dysfunction is biologically plausible in severe bronchiolitis, correcting this alone may be insufficient once respiratory failure is established.

Clinical takeaway: Routine use of endotracheal surfactant cannot be recommended for infants ventilated with severe bronchiolitis based on current evidence, but enrollment in clinical trials remains reasonable where available.

Source:

Mihalache A, et al. (2026, March 25). Neurology. Idiopathic Intracranial Hypertension Prevalence and Hormonal Contraception: A Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/41881051/