Randomized Controlled Trial of Lung Lavage with Dilute Surfactant for Meconium Aspiration Syndrome

• Published in: The Journal of pediatrics 2011-03, Vol.158 (3), p.383-389.e2
• Main Authors: Dargaville, Peter A., FRACP, MD, Copnell, Beverley, RN, BAppSc, PhD, Mills, John F., FRACP, PhD, Haron, Ismail, MD, Lee, Jimmy K.F., MD, Tingay, David G., FRACP, PhD, Rohana, Jaafar, MD, Mildenhall, Lindsay F., FRACP, Jeng, Mei-Jy, MD, PhD, Narayanan, Anushree, MD, Battin, Malcolm R., FRACP, Kuschel, Carl A., FRACP, Sadowsky, Joel L., FRACP, Patel, Harshad, FRACP, Kilburn, Charles J., FRACP, Carlin, John B., BSc(Hons), PhD, Morley, Colin J., FRACP, MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biological Products - administration & dosage; blood pressure; Bronchoalveolar Lavage; cattle; confidence interval; Extracorporeal Membrane Oxygenation; Female; General aspects; heart rate; High-Frequency Ventilation; Humans; Infant, Newborn; infants; Male; Meconium Aspiration Syndrome - therapy; Medical sciences; mortality; nitric oxide; Nitric Oxide - therapeutic use; odds ratio; oxygen; Pediatrics; Pneumology; Pulmonary Surfactants - administration & dosage; randomized clinical trials; Respiratory system : syndromes and miscellaneous diseases; surfactants; Survival Analysis; Time Factors
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.08.044

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.