Intratracheal catheter suction removes the same volume of meconium with less
impact on desaturation compared with meconium aspirator in meconium
Yohei Akazawa, Takefumi Ishida, Atsushi Baba, Takehiko Hiroma, Tomohiko Nakamura
Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
Received 9 June 2009
Received in revised form 22 June 2010
Accepted 22 June 2010
Meconium aspiration syndrome
Objective: To evaluate the impact of suction technique on the rate of meconium removal, oxygenation, and
hemodynamics in an animal experimental model of meconium aspiration syndrome (MAS).
Methods: MAS was induced in ventilated rabbits using 3.5 ml/kg of 20% human meconium. Tracheal suction
with either catheter suction (CS) or meconium aspirator (MA) was performed after meconium instillation.
Percentage of meconium collection rate, PaO
trends for 2 h after tracheal suction, and acute-phase SpO
trends were compared between CS and the other three groups, the tube was withdrawn while meconium
was aspirated with an MA, then the trachea was reintubated 5, 10 or 15 s after suctioning of meconium.
Results: Percentage of meconium collection rate and PaO
showed no signiﬁcant differences between groups.
The MA group taking 15 s for reintubation after meconium suctioning, showed a signiﬁcantly lower acute-
than the CS group (P b0.05). The time for SpO
to return to ≥ 90% was also longer in the MA
group taking 15 s for reintubation than in the CS group (P b0.05).
Conclusion: Intratracheal CS removed the same volume of meconium with less impact on desaturation
compared with meconium aspiration in an animal model of MAS. Intratracheal CS may be beneﬁt to remove
meconium in non-vigorous infants with meconium-stained amniotic ﬂuid at birth.
© 2010 Elsevier Ireland Ltd. All rights reserved.
Meconium aspiration syndrome (MAS) is a common cause of
respiratory distress in term and near-term infants .Infantswho
need intubation and mechanical ventilation due to MAS comprise
around 0.43 of 1000 live births and death related to MAS occurs in 0.96
per 100,000 live births . Approximately 8–15% of all infants are born
with evidence of meconium-stained amniotic ﬂuid (MSAF) and as many
as 2.5–4% of term infants may present with MSAF and less-than-
adequate “vigor” .AsMAScannotbepreventedinutero,removalof
meconium from the trachea as soon as possible after birth is
recommended to reduce the severity of MAS . The appropriate
intervention for MSAF as recommended by the Neonatal Resuscitation
Program (NRP) depends on whether the infant is “vigorous”,deﬁned as:
1) strong respiratory efforts; 2) good muscle tone; and 3) heart
rate ≥ 100 beats/min. When an infant is vigorous, the resuscitator
proceeds with routine management. However, if the infant is not
vigorous, the resuscitator inserts a laryngoscope into the larynx and
aspirates meconium from within the pharynx and larynx under direct
visualization using a 12- or 14-F suction tube. The trachea is then
intubated and connected to a meconium aspirator (MA) ﬁtted with a
suction tube. The central hole in the MA is closed so that aspiration
pressure is applied to the tracheal tube. The tracheal tube is withdrawn
while aspiration continues to remove meconium from within the
trachea. This process is repeated until either little additional meconium
is recovered or until the heart rate of the neonate indicates that
resuscitation must proceed without delay , so this method necessi-
tates reintubations in infants requiring repeated endotracheal suctioning
or management of artiﬁcial ventilation. Endotracheal intubation is an
invasive procedure that takes experience and skill to master and can be
associated with adverse effects including bradycardia, ﬂuctuations in
blood pressure, hypoxia and airway injury. Pediatric residents often
struggle to master this skill . Intratracheal suction through the
endotracheal tube (ETT) that is commonly employed for intubated
neonates in the neonatal intensive care unit is widely used to remove
intratracheal debris. With this method, the ETT can be left in place after
suctioning if necessary, allowing rapid repeated suctioning or a change
to artiﬁcial ventilation without reintubation. We hypothesized that
intratracheal suction with a catheter through the ETT would be
associated with less deterioration of neonatal vital signs and the same
basic effects compared to repeated intubation for aspiration using an MA.
We investigated the effects of both techniques on the removal rate of
meconium, oxygenation, and hemodynamics in a rabbit model of MAS.
Early Human Development 86 (2010) 499–502
⁎ Corresponding author. Tel.: +81 263 73 6700.
E-mail address: email@example.com (T. Nakamura).
0378-3782/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.
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