Premium
Therapeutic lung lavage in meconium aspiration syndrome: A preliminary report
Author(s) -
Dargaville Peter A,
Mills John F,
Copnell Beverley,
Loughnan Peter M,
McDougall Peter N,
Morley Colin J
Publication year - 2007
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2007.01130.x
Subject(s) - meconium aspiration syndrome , medicine , meconium , mean airway pressure , anesthesia , oxygenation , gastric lavage , bronchoalveolar lavage , pulmonary surfactant , lung , respiratory distress , therapeutic irrigation , surgery , pregnancy , fetus , genetics , physics , biology , thermodynamics
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.