title: Bronchoalveolar lavage with diluted porcine surfactant in mechanically ventilated term infants with meconium aspiration syndrome.
abstract: BACKGROUND
  To evaluate the efficacy and safety of bronchoalveolar lavage (BAL) with diluted porcine surfactant in mechanically ventilated term infants with severe acute respiratory distress syndrome (ARDS) due to meconium aspiration syndrome (MAS).
  
  
  METHODS
  Eight consecutive mechanically ventilated term infants with severe ARDS due to MAS underwent BAL with 15 mL/kg of diluted (5.3mg phospholipid/mL) surfactant saline suspension (porcine surfactant [Curosurf]). Treatment was administered slowly in aliquots of 2.5 mL. The mean age of neonates at treatment was 3.5 (range 1-8) hours. Heart rate, systemic blood pressure and oxygen saturation were monitored continuously. Arterial blood gases were measured immediately before treatment, and again at 3 and 6 hours post-treatment. Chest x-rays were taken 6 and 24 hours after treatment.
  
  
  RESULTS
  Radiological improvement was evident in all eight patients 6 hours post-treatment. Compared with pre-BAL values, significant improvements (p < 0.05) in mean values for partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, pH, arterial/alveolar O2 ratio and oxygenation index were documented at 3 and 6 hours after BAL. In all patients, tracheal fluids that had been meconium-stained prior to BAL were clear of meconium after BAL. Only one patient required nitric oxide therapy for transient pulmonary hypertension. No adverse sequelae of treatment occurred during the study.
  
  
  CONCLUSIONS
  BAL with dilute porcine surfactant administered slowly in 2.5 mL aliquots improved oxygenation and chest x-ray findings, without causing major adverse effects, in mechanically ventilated term infants with ARDS due to MAS.
authors.affiliation: Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Milan, Italy. intensivist@tiscali.it
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.forename: Silvia
authors.initials: S
authors.lastname: Bianchi
authors.forename: Francesca
authors.initials: F
authors.lastname: Castoldi
authors.forename: Paola
authors.initials: P
authors.lastname: Fontana
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavigioli
mesh_terms: D001688:Biological Products / Q000008:administration & dosage*; D018893:Bronchoalveolar Lavage / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000628:therapy*; D010743:Phospholipids / Q000008:administration & dosage*; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D012122:Ventilators, Mechanical
chemical_list: D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa