Comparative effects of bronchoalveolar lavage with saline, surfactant, or perfluorocarbon in experimental meconium aspiration syndrome.

Abstract

OBJECTIVE:

Today, in meconium aspiration syndrome, treatment focuses on bronchoalveolar lavage, because it removes meconium and proinflammatory factors from airways. This technique might be more effective if different solutions were used such as saline solution, a protein-free surfactant, or a perfluorocarbon, because these would be less inhibited by meconium proteins.

SETTING:

Pulmonary physiology research unit, Cruces Hospital.

DESIGN:

Prospective, randomized study.

SUBJECTS:

We studied 24 lambs (<6 days) on mechanical ventilation for 180 mins. Catheters were placed and femoral and pulmonary arteries pressures registered (systemic and pulmonary arterial pressures).

INTERVENTIONS:

Lambs were instilled with 20% meconium (3-5 mL/Kg) and were randomly assigned to one of the following groups (n = 6): control: only continuous mechanical ventilation; saline bronchoalveolar lavage: bronchoalveolar lavage with 30 mL/kg of saline solution; dilute surfactant bronchoalveolar lavage: bronchoalveolar lavage with 32 mL/kg of diluted surfactant (lucinactant, 10 mg/mL); or perfluorocarbon bronchoalveolar lavage: bronchoalveolar lavage with 30 mL/kg of perfluorocarbon.

MEASUREMENTS AND MAIN RESULTS:

Blood gases, cardiovascular parameters, and pulmonary mechanics were assessed. Meconium instillation produced severe hypoxia, hypercapnia, acidosis, and pulmonary hypertension with impairment of pulmonary mechanics (p < .05). Lung lavage with dilute surfactant resulted in the resolution of pulmonary hypertension as well as better gas exchange and pulmonary mechanics than the control group (p < .05). Bronchoalveolar lavage with perfluorocarbon produced a transient improvement in gas exchange and ventilatory indices in comparison with control and saline bronchoalveolar lavage groups.

CONCLUSIONS:

In lambs with meconium aspiration syndrome, bronchoalveolar lavage with diluted lucinactant is an effective therapy producing significant improvements in gas exchange, pulmonary hypertension, and pulmonary mechanics. In addition, bronchoalveolar lavage with perfluorocarbon appears to confer some advantages over lavage with equal volumes of saline or no lavage.

• Authors: Carmen Rey-Santano, Victoria E Mielgo, Elena Gastiasoro, Francisco J Alvarez-Diaz, Hector Lafuente, Adolfo Valls-i-Soler, Xabier Murgia
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 13 Issue 3 Pg. e187-94 (May 2012) ISSN: 1529-7535 [Print] United States
• PMID: 22079955 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Drug Combinations
• Fatty Alcohols
• Fluorocarbons
• Phosphatidylglycerols
• Proteins
• Pulmonary Surfactants
• lucinactant
• Sodium Chloride

Topics

• Animals
• Bronchoalveolar Lavage (methods)
• Disease Models, Animal
• Drug Combinations
• Fatty Alcohols (therapeutic use)
• Fluorocarbons (therapeutic use)
• Humans
• Infant, Newborn
• Meconium Aspiration Syndrome (therapy)
• Phosphatidylglycerols (therapeutic use)
• Proteins (therapeutic use)
• Pulmonary Surfactants (therapeutic use)
• Random Allocation
• Respiration, Artificial
• Sheep
• Sodium Chloride (therapeutic use)
• Treatment Outcome