Therapeutic lung lavage in meconium aspiration syndrome: a preliminary report.

Abstract

AIM:

To explore the effects of a large volume lung lavage procedure in ventilated infants with meconium aspiration syndrome.

METHODS:

Infants with severe meconium aspiration requiring high-frequency ventilation underwent lung lavage using dilute bovine surfactant at a phospholipid concentration of 5 mg/mL. Lavage aliquot volumes were increased through the case series, aiming to deliver two aliquots of 15 mL/kg in rapid sequence. Physiological effects of lavage were documented, and comparison was made with a group of infants with meconium aspiration requiring high-frequency ventilation, in whom lavage was not performed.

RESULTS:

Nine episodes of lavage were performed in eight infants at a median age of 23 h (range 8-83 h). Three infants underwent a lavage that was defined as potentially therapeutic (total lavage volume of at least 25 mL/kg administered before 24 h of age). Lavage was not associated with bradycardia or hypotension. Recovery of arterial oxygen saturation to above 80% was achieved within 12 min in all but one infant in whom oxygen saturation was below 80% at the outset. Mean airway pressure was significantly lower in the Therapeutic lavage group compared with non-lavaged infants in the first 48 h, with a trend towards improved oxygenation.

CONCLUSION:

Dilute surfactant lavage with aliquots of up to 15 mL/kg appears to be feasible in haemodynamically stable ventilated infants with meconium aspiration syndrome, and its efficacy deserves further investigation in a randomised controlled trial.

• Authors: Peter A Dargaville, John F Mills, Beverley Copnell, Peter M Loughnan, Peter N McDougall, Colin J Morley
• Journal: Journal of paediatrics and child health (J Paediatr Child Health) 2007 Jul-Aug Vol. 43 Issue 7-8 Pg. 539-45 ISSN: 1034-4810 [Print] Australia
• PMID: 17635682 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Pulmonary Surfactants

Topics

• Animals
• Bronchoalveolar Lavage (methods)
• Cattle
• Humans
• Infant, Newborn
• Meconium Aspiration Syndrome (physiopathology, therapy)
• Pulmonary Surfactants (administration & dosage)
• Treatment Outcome
• Ventilators, Mechanical