• Chih-Hsueh Lin, Mei-Jy Jeng, Benjamin Ing-Tiau Kuo, and Yu Ru Kou.
• 1Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 2Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 3Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan. 4Laboratory of Epidemiology and Biostatics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
• Pediatr Crit Care Me. 2016 Jun 1; 17 (6): e287-95.

ObjectivesTo evaluate the combined effects of surfactant lavage and intratracheally instillation of budesonide on meconium-injured piglet lungs.DesignA prospective, randomized, animal model study.SettingAn experimental laboratory.SubjectsTwenty-four anesthetized and mechanically ventilated newborn piglets.InterventionsHuman meconium slurry was intratracheally instilled into piglet lungs to induce lung injury. The injured piglets were randomly assigned to either the sham treatment group (control) or one of the three therapeutic groups: the intratracheally instilled budesonide (Bud) group, the bronchoalveolar lavage with diluted surfactant (dsBAL) group, and the combination therapy of Bud and dsBAL (dsBAL + Bud) group.Measurements And Main ResultsCardiopulmonary profiles were measured hourly. Proinflammatory cytokine (interleukin-1β, interleukin-6, and interleukin-8) levels in bronchoalveolar lavage fluid were measured. Finally, the pulmonary histology of the experimental subjects was examined at the end of experiments. Both of the lavaged groups (dsBAL and dsBAL + Bud) showed significantly better oxygenation than those that had not undergone lavage (control and Bud) (p < 0.05). The dsBAL + Bud group showed a significantly higher lung compliance and required a significantly lower peak inspiratory pressure during the experimental periods than the other three groups (p < 0.05). All treatment groups had significantly lower concentrations of interleukin-1β concentration in the bronchoalveolar lavage fluid than the control group (p < 0.05). The dsBAL + Bud group also had a significantly lower interleukin-6 concentration in the bronchoalveolar lavage fluid (p< 0.05), as well as a significantly lower lung injury score based on pulmonary histology than the control group (p < 0.05).ConclusionsTherapeutic bronchoalveolar lavage with diluted surfactant followed by intratracheal instillation of budesonide has a synergistic and beneficial effect when treating severe meconium-injured newborn piglet lungs.

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