Effects of therapeutic bronchoalveolar lavage and partial liquid ventilation on meconium-aspirated newborn piglets

Jeng, Mei Jy; Soong, Wen‐Jue; Lee, Yu Sheng; Chang, Hua Lun; Shen, Chung Min; Wang, Chua Ho; Yang, Shih-Chieh; Hwang, Betau

doi:10.1097/01.ccm.0000205662.60832.35

Cited by 23 publications

(26 citation statements)

References 33 publications

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“…However, the techniques of therapeutic BAL are quite different among reported animal (Table 1) (23,(25)(26)(27)30,(32)(33)(34)(35)40) and neonatal studies (Table 2) (24,28,29,31,36 -39). The biggest difference was the lavage volume of each aliquot (range: 2 mL/aliquot to 20 mL/ kg/aliquot) and lavage frequencies (range, 2-30 aliquots), thus resulting in a large difference in total lavage volume (range, 9 mL totally to 80 mL/kg) ( Tables 1 and 2).…”

Section: Econium Aspiration Syndrome (Mas) Is One Of the Topmentioning

confidence: 97%

“…This study was designed to test this hypothesis in an experimental model of newborn piglets with MAS (25).…”

Section: Econium Aspiration Syndrome (Mas) Is One Of the Topmentioning

confidence: 99%

“…Intervention to treat progressive MAS using BAL with saline has not proved to be clinically useful (15,16) and may even be detrimental as the volume of saline can further impede gas exchange and worsen lung mechanics. Some authors have tried to use bolus surfactant given after saline lavage (15,(17)(18)(19)(20), but the surfactant distribution was not uniformly obtained in the same manner as when using surfactant lavage (21,22).Recently, technique of therapeutic BAL with diluted exogenous surfactant has been tried and shown some promising benefits in improving pathophysiological responses, increasing meconium removal amount, lowering ventilation duration, and decreasing the severity of illness (12,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). However, the techniques of therapeutic BAL are quite different among reported animal (Table 1) (23,(25)(26)(27)30,(32)(33)(34)(35)40) and neonatal studies (Table 2) (24,28,29,31,36 -39).…”

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Effective Lavage Volume of Diluted Surfactant Improves the Outcome of Meconium Aspiration Syndrome in Newborn Piglets

2009

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Meconium aspiration syndrome (MAS) is one of the top causes of severe respiratory failure in neonates. This study was designed to investigate the effective volume of therapeutic bronchoalveolar lavage (BAL) with diluted surfactant in the treatment of MAS in newborn piglets. Human meconium was instilled in 24 piglets to induce MAS, and the piglets were randomly divided into four groups: 1) control, no lavage; 2) lavage-10, BAL with diluted surfactant (5 mg/mL, Survanta) 10 mL/kg in two aliquots; 3) lavage-20, 20 mL/kg in two aliquots; 4) lavage-30, 30 mL/kg in two aliquots. Cardiopulmonary parameters were monitored, and the lung tissue was histologically examined after experiments. The changes in oxygenation and lung compliance of lavage-20 and lavage-30 groups were significantly better than control and lavage-10 groups (p Ͻ 0.05), but there was no significant difference between lavage-20 and lavage-30 groups. The lung injury scores were significantly lower in the dependent site of lavage-20 and lavage-30 groups than the other two groups. In conclusion, using 20 mL/kg diluted surfactant in two aliquots to perform therapeutic BAL was as effective as 30 mL/kg in improving the pathophysiological outcomes in MAS and may warrant consideration clinically in treating MAS. Despite improvement in immediate resuscitation at birth and the use of assisted ventilation, respiratory distress caused by aspirated meconium is difficult to manage. Even with innovative respiratory care, some neonates with severe MAS may become candidates for extracorporeal membrane oxygenation and high rates of mortality may occur (1-3).The mechanisms in pathogenesis of MAS typically includes local obstruction of the airway by meconium debris, with associated impairment of gas diffusion, patchy atelectasis, pulmonary vascular hypertension, pulmonary inflammation, chemical pneumonitis, and surfactant inactivity (4 -10). Bolus surfactant administration has been tested for the treatment of MAS previously, but no significant reduction in mortality and other morbidities was obtained (11)(12)(13)(14).Effective meconium removal without inactivating or washing out surfactant is a potential additional treatment for treating MAS. Theoretically, the concept of therapeutic bronchoalveolar lavage (BAL) involves dilution and removal of the meconium from the airspaces. Intervention to treat progressive MAS using BAL with saline has not proved to be clinically useful (15,16) and may even be detrimental as the volume of saline can further impede gas exchange and worsen lung mechanics. Some authors have tried to use bolus surfactant given after saline lavage (15,(17)(18)(19)(20), but the surfactant distribution was not uniformly obtained in the same manner as when using surfactant lavage (21,22).Recently, technique of therapeutic BAL with diluted exogenous surfactant has been tried and shown some promising benefits in improving pathophysiological responses, increasing meconium removal amount, lowering ventilation duration, and decreasing the severity of ill...

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Section: Econium Aspiration Syndrome (Mas) Is One Of the Topmentioning

confidence: 97%

“…This study was designed to test this hypothesis in an experimental model of newborn piglets with MAS (25).…”

Section: Econium Aspiration Syndrome (Mas) Is One Of the Topmentioning

confidence: 99%

mentioning

confidence: 99%

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Effective Lavage Volume of Diluted Surfactant Improves the Outcome of Meconium Aspiration Syndrome in Newborn Piglets

2009

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“…78 Liquid ventilation with perfluorocarbons has been found beneficial in improving survival in animal models of MAS, offering research potential for its use in humans. 79 All these therapies are in experimental stage, with only animal studies available so far, and await further human trials. (1973 to 1987).…”

Section: Future Therapymentioning

confidence: 99%

Meconium aspiration syndrome: challenges and solutions

Goel¹,

Nangia²

2017

RRN

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Meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among term newborns. A result of antepartum or postpartum aspiration of meconium stained amniotic fluid (MSAF), MAS causes respiratory distress of varying severity, often complicated by air leaks or persistent pulmonary hypertension (PPHN). There has been a tremendous change in the concepts of pathophysiology and management of MAS over the last few decades. Routine endotracheal suctioning is no longer recommended in both vigorous and nonvigorous neonates with MSAF. Supportive management, along with newer therapies such as surfactant, inhaled nitric oxide, and high-frequency ventilation, has resulted in marked improvement in the overall outcome of MAS. The present review highlights the challenges in understanding the complex pathophysiology and optimal management approach to MAS. Potential future therapies and drugs in trial are also discussed briefly.

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“…[13][14][15][16] Additionally, studies on artificial mucus injection have been proposed to evaluate mucus transport, using artificial polymers with properties similar to those of human mucus. 17,18 Given the characteristics of newborn piglets, 19 these animals appear to be a promising model for the evaluation of respiratory interventions in newborns cared for in neonatal ICUs, and a pilot study investigated the feasibility of this animal model.…”

Section: Introductionmentioning

confidence: 99%

Experimental Model of Atelectasis in Newborn Piglets

Comaru¹,

Fiori²,

Fiori³

et al. 2013

Respir Care

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BACKGROUND: There are few studies using animal models in chest physical therapy. However, there are no models to assess these effects in newborns. This study aimed to develop a model of obstructive atelectasis induced by artificial mucus injection in the lungs of newborn piglets, for the study of neonatal physiotherapy. METHODS: Thirteen newborn piglets received artificial mucus injection via the endotracheal tube. X-rays and blood gas analysis confirmed the atelectasis. RESULTS: The model showed consistent results between oxygenation parameters and radiological findings. Ten (76.9%) of the 13 piglets responded to the intervention. This did not significantly differ from the expected percentage of 50% by the binomial test (95% CI 46.2-95%, P ‫؍‬ .09). CONCLUSIONS: Our model of atelectasis in newborn piglets is both feasible and appropriate to evaluate the impact of physical therapies on atelectasis in newborns.

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Effects of therapeutic bronchoalveolar lavage and partial liquid ventilation on meconium-aspirated newborn piglets

Abstract: Initial therapeutic BAL and therapeutic BAL followed by PLV with the same perfluorochemical liquid provided significant therapeutic effects in treating an animal model with severe MAS and therefore warrant consideration in cases that are intractable to other therapies.

Cited by 23 publications

References 33 publications

Effective Lavage Volume of Diluted Surfactant Improves the Outcome of Meconium Aspiration Syndrome in Newborn Piglets

Effective Lavage Volume of Diluted Surfactant Improves the Outcome of Meconium Aspiration Syndrome in Newborn Piglets

Meconium aspiration syndrome: challenges and solutions

Experimental Model of Atelectasis in Newborn Piglets

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