Management of meconium aspiration syndrome by tracheobronchial lavage and replacement of Surfactant‐TA

Abstract

Meconium aspiration syndrome creates mechanical airway obstruction with air trapping and atelectasis. Tracheobronchial saline lavage to dislodge meconium may precipitate respiratory distress, a wet lung appearance and respiratory failure. Two case studies are reported in which meconium aspiration resulted in mechanical obstruction and displacement of surfactant and in whom tracheobronchial saline lavage and artificial surfactant replacement reversed respiratory failure.

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

“…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).…”

“…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).…”

Therapeutic lung lavage in meconium aspiration syndrome: A preliminary report

“…Additionally, dilute surfactant has been found to be a more effective lavage fluid than saline 7,9 . In human infants the available data consist of a number of case series 13–20 and two small randomised controlled trials 21,22 . These investigations have suggested that lavage therapy may have a place in the management of MAS, although the lavage protocols used are widely disparate, with total lavage volumes ranging from 3 mL/kg to 48 mL/kg, and aliquot volumes of between 2 mL/kg and 15 mL/kg.…”

Therapeutic Lung Lavage in the Piglet Model of Meconium Aspiration Syndrome

“…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.…”

“…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. Considerable amounts of meconium appear to be removed by lavage, with improvement in postlavage lung function noted in studies comparing a lavage group with either historical (22,24) or randomized (27) controls in whom lavage was not performed.…”