Surfactant lavage and replacement in meconium aspiration syndrome with pulmonary hemorrhage

Kaneko, Mitsunobu; Watanabe, Jun; Ueno, Etsushi

doi:10.1515/jpm.2001.050

Cited by 16 publications

(16 citation statements)

References 17 publications

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“…In human infants, the available data on lavage therapy in MAS are limited to several case series (20)(21)(22)(23)(24)(25) and two small randomized controlled trials (26,27). These studies have used both saline (20,21,24) and dilute surfactant (22)(23)(24)(25)(26)(27) as lavage fluids, with total lavage volumes of 3 to 48 ml/kg, and aliquot volumes ranging from 2 to 15 ml/kg.…”

mentioning

confidence: 99%

Therapeutic Lung Lavage in the Piglet Model of Meconium Aspiration Syndrome

Dargaville

Mills

Headley

et al. 2003

Am J Respir Crit Care Med

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Therapeutic lung lavage is an emerging treatment for meconium aspiration syndrome. Our objective was to investigate the type of fluid and aliquot volume most appropriate for lung lavage in this condition. Meconium injury was induced in 2-week-old piglets, followed by a 30 ml/kg lavage in two aliquots 40 minutes later. Lavage with either dilute bovine surfactant (2.5 mg/ml) or a perfluorocarbon emulsion (20% wt/vol) improved oxygenation compared with a nonlavaged control group, but only with dilute surfactant was there a sustained improvement in oxygenation (alveolar-arterial oxygen difference at 5 hours: dilute surfactant 250 mm Hg; perfluorocarbon emulsion 460 mm Hg; controls 460 mm Hg; p = 0.0031). There was histologic and biochemical evidence of decreased lung injury in the dilute surfactant group. In a further study, 30 ml/kg dilute surfactant lavage was performed 40 minutes after meconium injury using either two aliquots of 15 ml/kg, or multiple 3-ml aliquots. Aliquot volume of 15 ml/kg was associated with increased meconium removal, better post-lavage lung function, and less lung injury. Dilute surfactant lavage using two 15-ml/kg aliquots is an effective therapy in the piglet model of meconium aspiration, and should be evaluated in human infants with this condition.

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confidence: 99%

Therapeutic Lung Lavage in the Piglet Model of Meconium Aspiration Syndrome

Dargaville

Mills

Headley

et al. 2003

Am J Respir Crit Care Med

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“…1 Different approaches have been proposed for the management of PH in newborn infants, including high airway pressures during mechanical ventilation, high frequency oscillation, 15 ECMO, 16 administration of recombinant activated Factor VII 17 and surfactant replacement therapy. 18 Although therapeutic lung lavage has been successfully used in MAS, with or without PH, 5,6,19 resulting in meconium removal from the alveoli and surfactant replacement such an approach has not been described for severe PH that can block central and peripheral airways similar to the situation in MAS. In our case we followed a small volume aliquot protocol, as our patient's extremely critical condition did not allow for the administration of larger lavage volumes as proposed for MAS.…”

Section: Discussionmentioning

confidence: 99%

Use of Therapeutic Surfactant Lavage in a Preterm Infant with Massive Pulmonary Hemorrhage

Kanavaki

Vutskits

Rimensberger

2012

Clinics and Practice

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We report a case of a premature infant presenting with recurrent pulmonary hemorrhage in which we performed a therapeutic lavage with diluted surfactant after an acute episode of bleeding with severe intractable hypoxemia. Repeated small aliquots of diluted surfactant (10×2 mL) allowed rapid improvement in oxygenation and reduction of required mean airway pressures during high frequency oscillatory ventilation. This observation may suggest that surfactant lavage could be beneficial in massive pulmonary hemorrhage in infants. A randomized controlled trial might be needed to clarify the potential benefit of this therapeutic intervention on outcome of infants suffering from this life-threatening complication.

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“…In an animal study comparing ETT to LMA surfactant delivery, it was reported that surfactant delivery could be accomplished sooner in the LMA group with equivalent efficacy. 85 7 In animal studies, distribution of intratracheally instilled surfactant has been largely determined by gravity, and unaffected by the position of the chest. 89 Therefore, leaving the chest in a horizontal position may result in the most even distribution of surfactant to the lungs.…”

Section: Laryngeal Mask Airway (Lma) Administrationmentioning

confidence: 99%

“…Surfactant deficiency is associated with onset of respiratory distress syndrome (RDS), a major cause of morbidity and mortality in premature infants. 2 Surfactant is also effective in treating infants with meconium aspiration syndrome (MAS), pulmonary hemorrhage, 7 and pneumonia, although the evidence base for their use in these disease processes is much weaker than the primary indication of RDS. 8,9 Surfactant reduces surface tension, improves lung compliance, and stabilizes lung volumes at a lower transpulmonary pressure.…”

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confidence: 99%

AARC Clinical Practice Guideline. Surfactant Replacement Therapy: 2013

et al. 2013

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We searched the MEDLINE, CINAHL, and Cochrane Library databases for English-language randomized controlled trials, systematic reviews, and articles investigating surfactant replacement therapy published between January 1990 and July 2012. By inspection of titles, references having no relevance to the clinical practice guideline were eliminated. The update of this clinical practice guideline is based on 253 clinical trials and systematic reviews, and 12 articles investigating surfactant replacement therapy. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation scoring system: 1: Administration of surfactant replacement therapy is strongly recommended in a clinical setting where properly trained personnel and equipment for intubation and resuscitation are readily available. 2: Prophylactic surfactant administration is recommended for neonatal respiratory distress syndrome (RDS) in which surfactant deficiency is suspected. 3: Rescue or therapeutic administration of surfactant after the initiation of mechanical ventilation in infants with clinically confirmed RDS is strongly recommended. 4: A multiple surfactant dose strategy is recommended over a single dose strategy. 5: Natural exogenous surfactant preparations are recommended over laboratory derived synthetic suspensions at this time. 6: We suggest that aerosolized delivery of surfactant not be utilized at this time.

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Surfactant lavage and replacement in meconium aspiration syndrome with pulmonary hemorrhage

Cited by 16 publications

References 17 publications

Therapeutic Lung Lavage in the Piglet Model of Meconium Aspiration Syndrome

Therapeutic Lung Lavage in the Piglet Model of Meconium Aspiration Syndrome

Use of Therapeutic Surfactant Lavage in a Preterm Infant with Massive Pulmonary Hemorrhage

AARC Clinical Practice Guideline. Surfactant Replacement Therapy: 2013

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