Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration

Satyanarayana Lakshminrusimha, Bobby Mathew, Jayasree Nair, Sylvia F. Gugino, Carmon Koenigsknecht, Munmun Rawat, Lori Nielsen, Daniel D. Swartz

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background:Current neonatal resuscitation guidelines recommend tracheal suctioning of nonvigorous neonates born through meconium-stained amniotic fluid.Methods:We evaluated the effect of tracheal suctioning at birth in 29 lambs with asphyxia induced by cord occlusion and meconium aspiration during gasping.Results:Tracheal suctioning at birth (n = 15) decreased amount of meconium in distal airways (53 ± 29 particles/mm 2 lung area) compared to no suction (499 ± 109 particles/mm 2; n = 14; P < 0.001). Three lambs in the suction group had cardiac arrest during suctioning, requiring chest compressions and epinephrine. Onset of ventilation was delayed in the suction group (146 ± 11 vs. 47 ± 3 s in no-suction group; P = 0.005). There was no difference in pulmonary blood flow, carotid blood flow, and pulmonary or systemic blood pressure between the two groups. Left atrial pressure was significantly higher in the suction group. Tracheal suctioning resulted in higher Pao 2 /FiO 2 levels (122 ± 21 vs. 78 ± 10 mm Hg) and ventilator efficiency index (0.3 ± 0.05 vs.0.16 ± 0.03). Two lambs in the no-suction group required inhaled nitric oxide. Lung 3-nitrotyrosine levels were higher in the suction group (0.65 ± 0.03 ng/μg protein) compared with the no-suction group (0.47 ± 0.06).Conclusion:Tracheal suctioning improves oxygenation and ventilation. Suctioning does not improve pulmonary/systemic hemodynamics or oxidative stress in an ovine model of acute meconium aspiration with asphyxia.

Original languageEnglish (US)
Pages (from-to)347-355
Number of pages9
JournalPediatric Research
Volume77
Issue number2
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Meconium Aspiration Syndrome
Suction
Gases
Hemodynamics
Lung
Meconium
Asphyxia
Ventilation
Parturition
Atrial Pressure
Amniotic Fluid
Mechanical Ventilators
Heart Arrest
Resuscitation
Epinephrine
Sheep
Nitric Oxide
Oxidative Stress
Thorax
Guidelines

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration. / Lakshminrusimha, Satyanarayana; Mathew, Bobby; Nair, Jayasree; Gugino, Sylvia F.; Koenigsknecht, Carmon; Rawat, Munmun; Nielsen, Lori; Swartz, Daniel D.

In: Pediatric Research, Vol. 77, No. 2, 01.01.2015, p. 347-355.

Research output: Contribution to journalArticle

Lakshminrusimha, S, Mathew, B, Nair, J, Gugino, SF, Koenigsknecht, C, Rawat, M, Nielsen, L & Swartz, DD 2015, 'Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration', Pediatric Research, vol. 77, no. 2, pp. 347-355. https://doi.org/10.1038/pr.2014.186
Lakshminrusimha, Satyanarayana ; Mathew, Bobby ; Nair, Jayasree ; Gugino, Sylvia F. ; Koenigsknecht, Carmon ; Rawat, Munmun ; Nielsen, Lori ; Swartz, Daniel D. / Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration. In: Pediatric Research. 2015 ; Vol. 77, No. 2. pp. 347-355.
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AU - Lakshminrusimha, Satyanarayana

AU - Mathew, Bobby

AU - Nair, Jayasree

AU - Gugino, Sylvia F.

AU - Koenigsknecht, Carmon

AU - Rawat, Munmun

AU - Nielsen, Lori

AU - Swartz, Daniel D.

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N2 - Background:Current neonatal resuscitation guidelines recommend tracheal suctioning of nonvigorous neonates born through meconium-stained amniotic fluid.Methods:We evaluated the effect of tracheal suctioning at birth in 29 lambs with asphyxia induced by cord occlusion and meconium aspiration during gasping.Results:Tracheal suctioning at birth (n = 15) decreased amount of meconium in distal airways (53 ± 29 particles/mm 2 lung area) compared to no suction (499 ± 109 particles/mm 2; n = 14; P < 0.001). Three lambs in the suction group had cardiac arrest during suctioning, requiring chest compressions and epinephrine. Onset of ventilation was delayed in the suction group (146 ± 11 vs. 47 ± 3 s in no-suction group; P = 0.005). There was no difference in pulmonary blood flow, carotid blood flow, and pulmonary or systemic blood pressure between the two groups. Left atrial pressure was significantly higher in the suction group. Tracheal suctioning resulted in higher Pao 2 /FiO 2 levels (122 ± 21 vs. 78 ± 10 mm Hg) and ventilator efficiency index (0.3 ± 0.05 vs.0.16 ± 0.03). Two lambs in the no-suction group required inhaled nitric oxide. Lung 3-nitrotyrosine levels were higher in the suction group (0.65 ± 0.03 ng/μg protein) compared with the no-suction group (0.47 ± 0.06).Conclusion:Tracheal suctioning improves oxygenation and ventilation. Suctioning does not improve pulmonary/systemic hemodynamics or oxidative stress in an ovine model of acute meconium aspiration with asphyxia.

AB - Background:Current neonatal resuscitation guidelines recommend tracheal suctioning of nonvigorous neonates born through meconium-stained amniotic fluid.Methods:We evaluated the effect of tracheal suctioning at birth in 29 lambs with asphyxia induced by cord occlusion and meconium aspiration during gasping.Results:Tracheal suctioning at birth (n = 15) decreased amount of meconium in distal airways (53 ± 29 particles/mm 2 lung area) compared to no suction (499 ± 109 particles/mm 2; n = 14; P < 0.001). Three lambs in the suction group had cardiac arrest during suctioning, requiring chest compressions and epinephrine. Onset of ventilation was delayed in the suction group (146 ± 11 vs. 47 ± 3 s in no-suction group; P = 0.005). There was no difference in pulmonary blood flow, carotid blood flow, and pulmonary or systemic blood pressure between the two groups. Left atrial pressure was significantly higher in the suction group. Tracheal suctioning resulted in higher Pao 2 /FiO 2 levels (122 ± 21 vs. 78 ± 10 mm Hg) and ventilator efficiency index (0.3 ± 0.05 vs.0.16 ± 0.03). Two lambs in the no-suction group required inhaled nitric oxide. Lung 3-nitrotyrosine levels were higher in the suction group (0.65 ± 0.03 ng/μg protein) compared with the no-suction group (0.47 ± 0.06).Conclusion:Tracheal suctioning improves oxygenation and ventilation. Suctioning does not improve pulmonary/systemic hemodynamics or oxidative stress in an ovine model of acute meconium aspiration with asphyxia.

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