ObjectiveProspective study of the efficacy of calf lung surfactant extract in pediatric respiratory failure.DesignMulti-institutional, prospective, randomized, controlled, unblinded trial.SettingEight pediatric intensive care units (ICU) of tertiary medical centers.Patientsor=to7.InterventionInstillation of intratracheal surfactant (80 mL/m2).Measurements and Main ResultsVentilator parameters, arterial blood gases, and derived oxygenation and ventilation indices were recorded before and at intervals after surfactant administration. Complications and outcome measures, including mortality, duration of mechanical ventilation, and length of pediatric ICU and hospital stay, were also examined. Patients who received surfactant demonstrated rapid improvement in oxygenation and, on average, were extubated 4.2 days (32%) sooner and spent 5 fewer days (30%) in pediatric intensive care than control patients. There was no difference in mortality or overall hospital stay. Surfactant administration was associated with no serious adverse effects.ConclusionsAdministration of calf lung surfactant extract, calfactant, appears to be safe and is associated with rapid improvement in oxygenation, earlier extubation, and decreased requirement for intensive care in children with acute hypoxemic respiratory failure. Further study is needed, however, before widespread use in pediatric respiratory failure can be recommended. (Crit Care Med 1999; 27:188-195)