Therapeutic lung lavage in the piglet model of meconium aspiration syndrome.
Therapeutic lung lavage is an emerging treatment for meconium aspiration syndrome. Our objective was to investigate the type of fluid and aliquot volume most appropriate for lung lavage in this condition. Meconium injury was induced in 2-week-old piglets, followed by a 30 ml/kg lavage in two aliquots 40 minutes later. Lavage with either dilute bovine surfactant (2.5 mg/ml) or a perfluorocarbon emulsion (20% wt/vol) improved oxygenation compared with a nonlavaged control group, but only with dilute surfactant was there a sustained improvement in oxygenation (alveolar-arterial oxygen difference at 5 hours: dilute surfactant 250 mm Hg; perfluorocarbon emulsion 460 mm Hg; controls 460 mm Hg; p = 0.0031). There was histologic and biochemical evidence of decreased lung injury in the dilute surfactant group. In a further study, 30 ml/kg dilute surfactant lavage was performed 40 minutes after meconium injury using either two aliquots of 15 ml/kg, or multiple 3-ml aliquots. Aliquot volume of 15 ml/kg was associated with increased meconium removal, better post-lavage lung function, and less lung injury. Dilute surfactant lavage using two 15-ml/kg aliquots is an effective therapy in the piglet model of meconium aspiration, and should be evaluated in human infants with this condition.
Dargaville
Peter A
PA
Department of Neonatology, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia. peter.dargaville@rch.org.au
Mills
John F
JF
Headley
Bevan M
BM
Chan
Yuen
Y
Coleman
Lee
L
Loughnan
Peter M
PM
Morley
Colin J
CJ
D000704:Analysis of Variance; D000818:Animals; D018893:Bronchoalveolar Lavage; D002417:Cattle; D004195:Disease Models, Animal; D005466:Fluorocarbons / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000187:drug effects; D008471:Meconium Aspiration Syndrome / Q000188:drug therapy*; D010101:Oxygen Consumption / Q000187:drug effects; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli / Q000187:drug effects; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D013552:Swine; D013997:Time Factors
D005466:Fluorocarbons; D011663:Pulmonary Surfactants