Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome.
OBJECTIVE
To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS).


METHODS
We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung. Control subjects received standard care, which in both groups included high frequency ventilation, nitric oxide, and, where available, extracorporeal membrane oxygenation (ECMO).


RESULTS
Sixty-six infants were randomized, with one ineligible infant excluded from analysis. Median duration of respiratory support was similar in infants who underwent lavage and control subjects (5.5 versus 6.0 days, P = .77). Requirement for high frequency ventilation and nitric oxide did not differ between the groups. Fewer infants who underwent lavage died or required ECMO: 10% (3/30) compared with 31% (11/35) in the control group (odds ratio, 0.24; 95% confidence interval, 0.060-0.97). Lavage transiently reduced oxygen saturation without substantial heart rate or blood pressure alterations. Mean airway pressure was more rapidly weaned in the lavage group after randomization.


CONCLUSIONS
Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO.
Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart, Australia. peter.dargaville@dhhs.tas.gov.au
Peter A
PA
Dargaville
Beverley
B
Copnell
John F
JF
Mills
Ismail
I
Haron
Jimmy K F
JK
Lee
David G
DG
Tingay
Jaafar
J
Rohana
Lindsay F
LF
Mildenhall
Mei-Jy
MJ
Jeng
Anushree
A
Narayanan
Malcolm R
MR
Battin
Carl A
CA
Kuschel
Joel L
JL
Sadowsky
Harshad
H
Patel
Charles J
CJ
Kilburn
John B
JB
Carlin
Colin J
CJ
Morley
D001688:Biological Products / Q000008:administration & dosage*; D018893:Bronchoalveolar Lavage; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000628:therapy*; D009569:Nitric Oxide / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D016019:Survival Analysis; D013997:Time Factors
D001688:Biological Products; D011663:Pulmonary Surfactants; D009569:Nitric Oxide; C072197:beractant