Use of therapeutic surfactant lavage in a preterm infant with massive pulmonary hemorrhage

Abstract

We report a case of a premature infant presenting with recurrent pulmonary hemorrhage in which we performed a therapeutic lavage with diluted surfactant after an acute episode of bleeding with severe intractable hypoxemia. Repeated small aliquots of diluted surfactant (10×2 mL) allowed rapid improvement in oxygenation and reduction of required mean airway pressures during high frequency oscillatory ventilation. This observation may suggest that surfactant lavage could be beneficial in massive pulmonary hemorrhage in infants. A randomized controlled trial might be needed to clarify the potential benefit of this therapeutic intervention on outcome of infants suffering from this life-threatening complication.

Keywords: prematurity.; pulmonary hemorrhage; surfactant lavage.

Figure 1

Chest X-Rays of the infant before (A) and after (B) the bronchoalveolar lavage with diluted surfactant. Note that mean airway pressures during high-frequency oscillatory ventilation dropped from 35 cm H₂O before the lavage (A) to 18 cm H2O after (B). The time frame between the two X-rays was 1.5 h.

Figure 2

Oxygen saturation (SO₂%), mean airway pressure and CO₂ values before and after the administration of surfactant lung lavage. The black arrow shows the moment of bolus surfactant and prothromplex administration. The white arrow shows the moment of administration of lung lavage.