Lung Lavage with KL4 Surfactant in a Neonatal Model of Meconium Aspiration; The Importance of Peep. † 960

Barrington, Keith J.; Henderson, Christopher R.; Cochrane, Charles C; Rivak, Susan D; Finer, Neil N.; Allen, George R.

doi:10.1203/00006450-199804001-00981

Cited by 5 publications

(3 citation statements)

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“…Therefore, the preinjury alveolar-arterial oxygen difference might be worse than for a normal infant breathing spontaneously with room air (10,17,18,28). Using a higher PEEP to maintain lung volume to prevent atelectasis and lower inspiratory time to prevent air-trapping may further improve the therapeutic outcome in these animals (30).…”

Section: Discussionmentioning

confidence: 98%

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

Jeng¹,

Soong

Lee

et al. 2006

Critical Care Medicine

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Section: Discussionmentioning

confidence: 98%

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

Jeng¹,

Soong

Lee

et al. 2006

Critical Care Medicine

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“…Investigators have shown a beneficial effect of higher positive end expiratory pressure with Surfaxin lavage in animals with meconium aspiration. 86 Following Surfaxin lavage, compared with saline or perfluorocarbon lavage, Antunes and colleagues 87 have observed elevated disaturated phosphatidylcholine, SP-A, and SP-B levels in a rat model of MAS.…”

Section: Mas and Lung Lavagementioning

confidence: 99%

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Fuloria

Wiswell

1999

J Perinatol

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The term meconium was originally coined by Aristotle who used the Greek word meconium-arion 1 meaning "opium-like," because he believed meconium induced fetal sleep. It is probable that he recognized the association between the presence of meconium in the amniotic fluid and the occurrence of fetal deaths and neonatal depression.Depending on the population studied, the frequency of meconium-stained amniotic fluid (MSAF) at the time of delivery is variable, ranging between approximately 8% and 19% of all term deliveries. [2][3][4][5][6][7][8] Alexander and colleagues 9 noted a 1.5-fold increased risk for MSAF in black women compared with white women. The authors recommended that maternal ethnicity be viewed as a risk indicator of, and not a causal factor for, MSAF. They also observed an increased likelihood of MSAF with increasing gestational age in both ethnic groups.Regardless of the reason for meconium passage, its presence may be associated with adverse fetal and neonatal outcomes, including death, acute respiratory complications, and long-term pulmonary and neurologic abnormalities. Depending on various factors, including the population studied and the criteria used for making a diagnosis, meconium aspiration syndrome (MAS) will develop in 2% to 33% of infants born through MSAF. 3,4,10,11 As many as 30% or more of infants with MAS require mechanical ventilation. 3,12 Accompanying persistent pulmonary hypertension of the newborn (PPHN) is present in approximately one-third of these infants. 13 The mortality associated with MAS is disturbingly high, ranging from 4% to 19% 3,12,14 ; a large proportion of this mortality is attributable to PPHN.Early-onset neonatal seizures, secondary to hypoxic events, have been reported in infants born through thick MSAF. 15 Berkus et al. 16 observed a sevenfold increased risk of neonatal seizures and a fivefold increased likelihood of hypotonia in infants born through moderate to thick compared with thin meconium-stained or clear amniotic fluid. Some investigators have noted an increased likelihood of cerebral palsy in surviving infants with a low Apgar score who were born through MSAF. 17 In addition, there may be long-term pulmonary sequelae associated with MAS. Yuksel et al. 18 have shown increased functional residual capacity and airway reactivity at 6 months of age in infants with MAS; infants who required more respiratory support in the neonatal period had significantly more symptoms and required bronchodilator therapy more often. MAS has also been implicated in increased airway reactivity and abnormal pulmonary function tests in later childhood. 19,20 PATHOPHYSIOLOGY OF MECONIUM PASSAGEMeconium is a viscous green substance composed primarily of water (72% to 80%). Other components of meconium include gastrointestinal secretions, bile, bile acids, mucus, pancreatic juice, cellular debris, and swallowed amniotic fluid, lanugo, vernix caseosa, and blood. 1,21 The substance may first be noted in the fetal gastrointestinal tract as early as 10 to 16 weeks' gestation. At birt...

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“…In order to minimise the transient deleterious effect of lavage on oxygenation, several investigative groups have proposed that both instillation and recovery of lavage fluid should be undertaken with positive pressure ventilation, or at the very least positive end-expiratory pressure, being applied throughout [11,15,19]. Recent studies would suggest that this approach significantly compromises the effectiveness of the lavage procedure with disconnection from ventilation during suctioning (i.e.…”

Section: Surfactant Lavage Therapymentioning

confidence: 99%

Innovation in Surfactant Therapy I: Surfactant Lavage and Surfactant Administration by Fluid Bolus Using Minimally Invasive Techniques

Dargaville¹

2012

Neonatology

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Innovation in the field of exogenous surfactant therapy continues more than two decades after the drug became commercially available. One such innovation, lung lavage using dilute surfactant, has been investigated in both laboratory and clinical settings as a treatment for meconium aspiration syndrome (MAS). Studies in animal models of MAS have affirmed that dilute surfactant lavage can remove meconium from the lung, with resultant improvement in lung function. In human infants both non-randomised studies and two randomised controlled trials have demonstrated a potential benefit of dilute surfactant lavage over standard care. The largest clinical trial, performed by our research group in infants with severe MAS, found that lung lavage using two 15-ml/kg aliquots of dilute surfactant did not reduce the duration of respiratory support, but did appear to reduce the composite outcome of death or need for extracorporeal membrane oxygenation. A further trial of lavage therapy is planned to more precisely define the effect on survival. Innovative approaches to surfactant therapy have also extended to the preterm infant, for whom the more widespread use of continuous positive airway pressure (CPAP) has meant delaying or avoiding administration of surfactant. In an effort to circumvent this problem, less invasive techniques of bolus surfactant therapy have been trialled, including instillation directly into the pharynx, via laryngeal mask and via brief tracheal catheterisation. In a recent clinical trial, instillation of surfactant into the trachea using a flexible feeding tube was found to reduce the need for subsequent intubation. We have developed an alternative method of brief tracheal catheterisation in which surfactant is delivered via a semi-rigid vascular catheter inserted through the vocal cords under direct vision. In studies to date, this technique has been relatively easy to perform, and resulted in rapid improvement in lung function and reduced need for subsequent ventilation and duration of oxygen therapy. We are now commencing large-scale clinical trials of this method in preterm infants on CPAP.

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Lung Lavage with KL4 Surfactant in a Neonatal Model of Meconium Aspiration; The Importance of Peep. † 960

Cited by 5 publications

References 0 publications

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

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

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Innovation in Surfactant Therapy I: Surfactant Lavage and Surfactant Administration by Fluid Bolus Using Minimally Invasive Techniques

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