Surfactant lavage!

[Hamed]

Surfactant lavage, a therapeutic intervention used in Japan, although I have doubts about this intervention, it would be nice to know whether other NICUs out there use it.

Do you use surfactant lavage in your unit?  

If “Yes” 

What are the possible indications? 

What surfactant/saline ratio do you use?

Would you use in atelectatic changes in BPD cases suspecting thick secretions to be causing the atelectasis?

 

[Stefan Johansson]

To the best of my knowledge, I don't think this is used in Sweden.

What are the indications for lavage in Japan? Meconium aspiration? Or also preterm RDS??

Would be great to hear also HOW you do this and your experience.

[yangw126]

I have no experience .No neonatologist used surfactant lavage in my NICU .

[Hamed]

On 6/22/2018 at 3:03 AM, Stefan Johansson said:

To the best of my knowledge, I don't think this is used in Sweden.

What are the indications for lavage in Japan? Meconium aspiration? Or also preterm RDS??

Would be great to hear also HOW you do this and your experience.

Up to my knowledge from our unit`s practice and consulting a friend from another NICU in Tokyo.

Concentration: using 1 vial of surfactant (120 mg) to 6 CC up to 10 CC of saline (ie, making a concentration of 12mg/ml ~ 20mg/ml)

Administration: administered via a size 3 Fr OG tube, 2CC of the prepared surfactant concentration mentioned above is injected and pulled out using 2~ 5 CC syringe and repeated with another 2CC until the 6 ~10 CC is all used.

Indications include: 

MAS requiring intubation and mech. vent. with high settings.

Pulmonary Hemorrhage.

RDS with evolving BPD, intubated and mech. vent. using high settings with X-ray showing a heterogeneous distribution of lung atelectasis. 

Concerning my experience: I can say it shows a beneficial effect in MAS and pulmonary hemorrhage, but less effective in RDS with evolving BPD. However, I don't think it shows more beneficial effect than surfactant administration as a  practice used in all NICUs. Although that been said, an RCT is warranted to reach an evidence-based conclusion. 

Hoping to know if other countries have such a practice. We didn't use in Canada though. 

[Dr Ashish Jain]

This is near to something that was used in the LESS MAS trail . 

However , after the metaanalysis published by Natarajan et al , even the bolus surfactant shown have similar results .

Are other NICU using the Bolus Sf for MAS as of now (especially the atelactic ones)

 

[bimalc]

On 6/27/2018 at 9:50 AM, Dr Ashish Jain said:

Are other NICU using the Bolus Sf for MAS as of now (especially the atelactic ones)

Yes, we are in USA (3 different states I have practiced in)

[William Walsh]

I wrote an article in Peds Research in 1992 describing LACK of efficacy of surfactant lovage at 10cc/ kg for MAS. In piglet model. Surfactant was beneficial but lavage never came back with meconium. I tried because of earlier saline lavage studies with worsening of disease with saline washing out surfactant. William Walsh

[M C Fadous Khalife]

We use surfactant bolus but never used surfactant lavage 

I find the idea only interesting in pulmonary hemorrage ; since we have high mortality , Does anyone have experienced surfactant lavage in pulmonary hemorrage? 

[bimalc]

8 hours ago, M C Fadous Khalife said:

Does anyone have experienced surfactant lavage in pulmonary hemorrage?

No, but we will give bolus surfactant (RDS dosing) after pulmonary hem. with hypoxia

[Dr Khalil Ahmad]

I have found timely use of surfactant very useful in MAS, not in all cases only those on very high vent settings and not responding, it help in weaning off from ventilator.

[Hamed]

On 7/12/2018 at 4:03 AM, M C Fadous Khalife said:

We use surfactant bolus but never used surfactant lavage 

I find the idea only interesting in pulmonary hemorrage ; since we have high mortality , Does anyone have experienced surfactant lavage in pulmonary hemorrage? 

Yes, please check my writings above @M C Fadous Khalife if you have further concerns, I would be happy to help out.