title: Therapeutic lung lavage in meconium aspiration syndrome: a preliminary report.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia. peter.dargaville@dhhs.tas.gov.au
authors.forename: Peter A
authors.initials: PA
authors.lastname: Dargaville
authors.forename: John F
authors.initials: JF
authors.lastname: Mills
authors.forename: Beverley
authors.initials: B
authors.lastname: Copnell
authors.forename: Peter M
authors.initials: PM
authors.lastname: Loughnan
authors.forename: Peter N
authors.initials: PN
authors.lastname: McDougall
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Morley
mesh_terms: D000818:Animals; D018893:Bronchoalveolar Lavage / Q000379:methods*; D002417:Cattle; D006801:Humans; D007231:Infant, Newborn; D008471:Meconium Aspiration Syndrome / Q000503:physiopathology / Q000628:therapy*; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D016896:Treatment Outcome; D012122:Ventilators, Mechanical
chemical_list: D011663:Pulmonary Surfactants