Selective medicated (normal saline and exogenous surfactant) bronchoalveolar lavage in severe aspiration syndrome in children.
OBJECTIVE
To study the ability of volume-controlled ventilation and medicated (normal saline plus surfactant) bronchoalveolar lavage in aspiration to reduce the duration of intubation and improve gas exchange.


METHODS
: Randomized controlled clinical trial.


METHODS
Pediatric intensive care unit.


METHODS
Twenty children, 1 month to 16 yrs old, who were intubated and mechanically ventilated, were randomized within 6 hrs of aspiration to receive volume-controlled ventilation plus medicated bronchoalveolar lavage (treatment group) or the same ventilation and bronchosuction (control group).


METHODS
Volume-controlled ventilation and positive end-expiratory pressure (10-12 cm H2O) were applied. Medicated bronchoalveolar lavage was performed using five aliquots of 5 mL of saline plus 10 mg/mL Curosurf (porcine surfactant, Chiesi Pharmaceutical SpA, Parma, Italy) in infants, five boluses of 10 mL of saline plus 5 mg/mL Curosurf in children, and four boluses of 25 mL of saline with 2.4 mg/mL Curosurf in adolescents for each affected lobe. One hour after bronchoalveolar lavage, 240 mg of Curosurf was administered locally.


RESULTS
All patients survived. In the treatment group, days of intubation were 4.6 (+/-1.07), oxygenation index and Pao2/Fio2 improved significantly at 24 hrs, and statistical reduction in tidal volume mL/kg was observed from 36 hrs. In the control group, days of intubation were 11.8 (+/-3.22) (p < .0001), no improvement in oxygenation was noted, and pneumonia was observed in seven children (70%).


CONCLUSIONS
Even though this was an unblinded small clinical trial and low tidal volume strategy was not employed at an early stage after lung injury, there is some evidence that bronchoalveolar lavage with normal saline and surfactant may have clinical value in treating severe aspiration syndrome in children. More clinical studies are warranted to overcome study limitations and potential bias.
Marraro
Giuseppe A
GA
Anesthesia and Intensive Care Department, Pediatric Intensive Care Unit, Fatebenefratelli and Ophtalmiatric Hospital, Milan, Italy. gmarraro@picu.it
Luchetti
Marco
M
Spada
Claudio
C
Galassini
Elena
E
Giossi
Massimo
M
Piero
Alessandro Monici Preti
AM
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology; D001688:Biological Products / Q000627:therapeutic use*; D018893:Bronchoalveolar Lavage / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D010743:Phospholipids / Q000627:therapeutic use*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D053120:Respiratory Aspiration / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D012965:Sodium Chloride / Q000627:therapeutic use
D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; D012965:Sodium Chloride; C068291:poractant alfa; D010100:Oxygen