Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome

Peter A. Dargaville, Beverley Copnell, John F. Mills, Ismail Haron, Jimmy K F Lee, David G. Tingay, Rohana Jaafar, Lindsay F. Mildenhall, Mei Jy Jeng, Anushree Narayanan, Malcolm R. Battin, Carl A. Kuschel, Joel L. Sadowsky, Harshad Patel, Charles J. Kilburn, John B. Carlin, Colin J. Morley

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
JournalJournal of Pediatrics
Volume158
Issue number3
DOIs
Publication statusPublished - Mar 2011

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Meconium Aspiration Syndrome
Bronchoalveolar Lavage
Surface-Active Agents
Therapeutic Irrigation
Randomized Controlled Trials
Extracorporeal Membrane Oxygenation
High-Frequency Ventilation
Nitric Oxide
Random Allocation
Heart Rate
Odds Ratio
Confidence Intervals
Oxygen
Blood Pressure
Pressure
Lung
Control Groups
Mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Dargaville, P. A., Copnell, B., Mills, J. F., Haron, I., Lee, J. K. F., Tingay, D. G., ... Morley, C. J. (2011). Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. Journal of Pediatrics, 158(3). https://doi.org/10.1016/j.jpeds.2010.08.044

Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. / Dargaville, Peter A.; Copnell, Beverley; Mills, John F.; Haron, Ismail; Lee, Jimmy K F; Tingay, David G.; Jaafar, Rohana; Mildenhall, Lindsay F.; Jeng, Mei Jy; Narayanan, Anushree; Battin, Malcolm R.; Kuschel, Carl A.; Sadowsky, Joel L.; Patel, Harshad; Kilburn, Charles J.; Carlin, John B.; Morley, Colin J.

In: Journal of Pediatrics, Vol. 158, No. 3, 03.2011.

Research output: Contribution to journalArticle

Dargaville, PA, Copnell, B, Mills, JF, Haron, I, Lee, JKF, Tingay, DG, Jaafar, R, Mildenhall, LF, Jeng, MJ, Narayanan, A, Battin, MR, Kuschel, CA, Sadowsky, JL, Patel, H, Kilburn, CJ, Carlin, JB & Morley, CJ 2011, 'Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome', Journal of Pediatrics, vol. 158, no. 3. https://doi.org/10.1016/j.jpeds.2010.08.044
Dargaville, Peter A. ; Copnell, Beverley ; Mills, John F. ; Haron, Ismail ; Lee, Jimmy K F ; Tingay, David G. ; Jaafar, Rohana ; Mildenhall, Lindsay F. ; Jeng, Mei Jy ; Narayanan, Anushree ; Battin, Malcolm R. ; Kuschel, Carl A. ; Sadowsky, Joel L. ; Patel, Harshad ; Kilburn, Charles J. ; Carlin, John B. ; Morley, Colin J. / Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. In: Journal of Pediatrics. 2011 ; Vol. 158, No. 3.
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AU - Copnell, Beverley

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AU - Haron, Ismail

AU - Lee, Jimmy K F

AU - Tingay, David G.

AU - Jaafar, Rohana

AU - Mildenhall, Lindsay F.

AU - Jeng, Mei Jy

AU - Narayanan, Anushree

AU - Battin, Malcolm R.

AU - Kuschel, Carl A.

AU - Sadowsky, Joel L.

AU - Patel, Harshad

AU - Kilburn, Charles J.

AU - Carlin, John B.

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N2 - 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.

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