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Selective medicated (normal saline and exogenous surfactant) bronchoalveolar lavage in severe aspiration syndrome in children*

Marraro, Giuseppe A. MD; Luchetti, Marco MD; Spada, Claudio MISM; Galassini, Elena MD; Giossi, Massimo PharmD; Piero, Alessandro Monici Preti MD

Pediatric Critical Care Medicine: September 2007 - Volume 8 - Issue 5 - p 476-481
doi: 10.1097/01.PCC.0000282158.09783.7C
Clinical Investigation

Objective: To study the ability of volume-controlled ventilation and medicated (normal saline plus surfactant) bronchoalveolar lavage in aspiration to reduce the duration of intubation and improve gas exchange.

Design: Randomized controlled clinical trial.

Setting: Pediatric intensive care unit.

Patients: Twenty children, 1 month to 16 yrs old, who were intubated and mechanically ventilated, were randomized within 6 hrs of aspiration to receive volume-controlled ventilation plus medicated bronchoalveolar lavage (treatment group) or the same ventilation and bronchosuction (control group).

Interventions: Volume-controlled ventilation and positive end-expiratory pressure (10–12 cm H2O) were applied. Medicated bronchoalveolar lavage was performed using five aliquots of 5 mL of saline plus 10 mg/mL Curosurf (porcine surfactant, Chiesi Pharmaceutical SpA, Parma, Italy) in infants, five boluses of 10 mL of saline plus 5 mg/mL Curosurf in children, and four boluses of 25 mL of saline with 2.4 mg/mL Curosurf in adolescents for each affected lobe. One hour after bronchoalveolar lavage, 240 mg of Curosurf was administered locally.

Measurements and Main Results: All patients survived. In the treatment group, days of intubation were 4.6 (±1.07), oxygenation index and Pao2/Fio2 improved significantly at 24 hrs, and statistical reduction in tidal volume mL/kg was observed from 36 hrs. In the control group, days of intubation were 11.8 (±3.22) (p < .0001), no improvement in oxygenation was noted, and pneumonia was observed in seven children (70%).

Conclusions: Even though this was an unblinded small clinical trial and low tidal volume strategy was not employed at an early stage after lung injury, there is some evidence that bronchoalveolar lavage with normal saline and surfactant may have clinical value in treating severe aspiration syndrome in children. More clinical studies are warranted to overcome study limitations and potential bias.

From the Anesthesia and Intensive Care Department, Pediatric Intensive Care Unit, Fatebenefratelli and Ophtalmiatric Hospital, Milan, Italy (GAM, ML, CS, EG); and the Project Management Department (MG) and Corporate Medical Department (APMP), Chiesi Pharmaceutical SpA, Parma, Italy.

*See also p. 505.

Drs. Giossi and Monici Preti Piero are employees of Chiesi Pharmaceutical SpA, Parma, Italy, the developer of Curosurf. Their contribution is limited to a discussion of the rationale underlying the study, statistical analysis, and interpretation of the data. The remaining authors have not disclosed any potential conflicts of interest.

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©2007The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies