Randomized Controlled Trial of Lung Lavage with Dilute Surfactant for Meconium Aspiration Syndrome

被引:64
作者
Dargaville, Peter A. [1 ,2 ,3 ,4 ,5 ]
Copnell, Beverley [4 ,5 ,6 ]
Mills, John F. [4 ,5 ]
Haron, Ismail [7 ]
Lee, Jimmy K. F. [8 ]
Tingay, David G. [4 ,5 ]
Rohana, Jaafar [9 ]
Mildenhall, Lindsay F. [10 ]
Jeng, Mei-Jy [11 ]
Narayanan, Anushree [12 ]
Battin, Malcolm R. [13 ]
Kuschel, Carl A. [13 ,14 ]
Sadowsky, Joel L. [15 ,16 ]
Patel, Harshad [16 ]
Kilburn, Charles J. [17 ]
Carlin, John B. [18 ]
Morley, Colin J. [4 ,5 ,14 ]
机构
[1] Royal Hobart Hosp, Dept Paediat, Hobart, Tas 7000, Australia
[2] Univ Tasmania, Hobart, Tas, Australia
[3] Menzies Res Inst, Hobart, Tas, Australia
[4] Royal Childrens Hosp, Dept Neonatol, Melbourne, Vic, Australia
[5] Murdoch Childrens Res Inst, Melbourne, Vic, Australia
[6] Monash Univ, Sch Nursing & Midwifery, Melbourne, Vic, Australia
[7] Selayang Hosp, Dept Paediat, Selangor, Malaysia
[8] Hosp Sultanah Nur Zahirah, Dept Paediat, Kuala Terengganu, Malaysia
[9] Univ Kebangsaan Malaysia, Dept Paediat, Med Ctr, Kuala Lumpur, Malaysia
[10] Middlemore Hosp, Newborn Serv, Auckland 6, New Zealand
[11] Taipei Vet Gen Hosp, Dept Paediat, Taipei, Taiwan
[12] KK Womens & Childrens Hosp, Dept Neonatol, Singapore, Singapore
[13] Auckland City Hosp, Newborn Serv, Auckland, New Zealand
[14] Royal Womens Hosp, Neonatal Serv, Melbourne, Australia
[15] Mercy Hosp Women, Dept Paediat, Melbourne, Vic, Australia
[16] Wellington Hosp, Neonatal Unit, Wellington, New Zealand
[17] Royal Darwin Hosp, Dept Paediat, Darwin, NT, Australia
[18] Murdoch Childrens Res Inst, Clin Epidemiol & Biostat Unit, Melbourne, Vic, Australia
基金
英国医学研究理事会;
关键词
STAINED AMNIOTIC-FLUID; EXOGENOUS SURFACTANT; MULTICENTER; MODEL; DELIVERY; THERAPY; INJURY;
D O I
10.1016/j.jpeds.2010.08.044
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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. (J Pediatr 2011;158:383-9).
引用
收藏
页码:383 / U58
页数:9
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