Therapeutic lung lavage in meconium aspiration syndrome: a preliminary report.
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.
Dargaville
Peter A
PA
Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia. peter.dargaville@dhhs.tas.gov.au
Mills
John F
JF
Copnell
Beverley
B
Loughnan
Peter M
PM
McDougall
Peter N
PN
Morley
Colin J
CJ
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
D011663:Pulmonary Surfactants