Randomized Controlled Trial of Lung Lavage with Dilute Surfactant for Meconium Aspiration Syndrome - 20/08/11
, Beverley Copnell, RN, BAppSc, PhD c, d, e, John F. Mills, FRACP, PhD c, d, Ismail Haron, MD f, Jimmy K.F. Lee, MD g, David G. Tingay, FRACP, PhD c, d, Jaafar Rohana, MD h, Lindsay F. Mildenhall, FRACP i, Mei-Jy Jeng, MD, PhD j, Anushree Narayanan, MD k, Malcolm R. Battin, FRACP l, Carl A. Kuschel, FRACP l, m, Joel L. Sadowsky, FRACP n, o, Harshad Patel, FRACP o, Charles J. Kilburn, FRACP p, John B. Carlin, BSc(Hons), PhD q, Colin J. Morley, FRACP, MD c, d, mon behalf of the lessMAS Trial Study Group
Reprint requests: A/Prof Peter Dargaville, MBBS, FRACP, MD, Department of Paediatrics, Royal Hobart Hospital, Liverpool Street, Hobart, Tasmania, Australia 7000.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.
Le texte complet de cet article est disponible en PDF.Mots-clés : AaDO2, CPAP, ECMO, HFOV, iNO, MAS, OI, PAW
Plan
| Supported by grants from the Australian National Health and Medical Research Council (284539 and 384100) and the Murdoch Childrens Research Institute. Abbott Pty Ltd. provided surfactant for lavaged infants. The funding sources had no role in the study design, data collection, data analysis, or preparation of the report. The authors declare no conflicts of interest. |
|
| This trial is registered with the Australia and New Zealand (Clinical Trial Register #12606000290594). |
Vol 158 - N° 3
P. 383 - mars 2011 Retour au numéro
Article précédent
- Influence of Gestational Age on Fibrinolysis from Birth to Postnatal Day 10
- Loïc Sentilhes, Philippe Leroux, Sophie Radi, Aude Ricbourg-Schneider, Vincent Laudenbach, Loïc Marpeau, Jacques Bénichou, Marc Vasse, Stéphane Marret
- Dynamics and Clinical Evolution of Bacterial Gut Microflora in Extremely Premature Patients
- Aurelien Jacquot, Dorine Neveu, Fabien Aujoulat, Gregoire Mercier, Hélène Marchandin, Estelle Jumas-Bilak, Jean-Charles Picaud
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?