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Published ahead of print on April 24, 2003, doi:10.1164/rccm.200301-121OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 4, August 2003, 456-463

A more recent version of this article appeared on August 15, 2003
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Submitted on January 28, 2003
Accepted on April 20, 2003

Therapeutic Lung Lavage In The Piglet Model of Meconium Aspiration Syndrome

Peter A Dargaville1*, John F Mills1, Bevan M Headley2, Yuen Chan3, Lee Coleman4, Peter M Loughnan2, and Colin J Morley2

1 Neonatology, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Melbourne, VIC, Australia, 2 Neonatology, Royal Children's Hospital, Melbourne, VIC, Australia, 3 Anatomical Pathology, Royal Children's Hospital, Melbourne, VIC, Australia, 4 Radiology, Royal Children's Hospital, Melbourne, VIC, Australia

* To whom correspondence should be addressed. E-mail: peter.dargaville{at}rch.org.au.

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 two-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% w/v) improved oxygenation compared with a non-lavaged 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 histological 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.
Key words: meconium aspiration syndrome, pulmonary surfactants, pulmonary lavage, perfluorocarbon




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