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Randomized controlled trial of lung lavage with dilute surfactant for Meconium Aspiration Syndrome

journal contribution
posted on 2023-05-17, 12:10 authored by Peter DargavillePeter Dargaville, Copnell, B, Mills, JF, Haron, I, Lee, JKF, Tingay, DG, Rohana, J, Mildenhall, LF, Jeng, M, Narayanan, A, Battin, MR, Kuschel, CA, Sadowsky, JL, Patel, H, Kilburn, CJ, Carlin, JB, Morley, CJ

Objective To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS).

Study design 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.

Conclusion Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO

History

Publication title

The Journal of Pediatrics

Volume

158

Pagination

383-389

ISSN

0022-3476

Department/School

Menzies Institute for Medical Research

Publisher

Mosby

Place of publication

11830 Westline Industrial Dr, St Louis, USA, Mo, 63146-3318

Rights statement

Copyright 2011 Mosby Inc.

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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