TY - JOUR
AU1 - Bent, Rebecca C.
AU2 - Wiswell, Thomas E.
AU3 - Chang, Audrey
AB - Abstract • Objective. —At least nine mechanical devices are available for suctioning the tracheae of meconium-stained newborns. To our knowledge, the efficacy of these devices, as well as various suction pressures and patterns, has not been previously compared. We performed this investigation to assess these variables. Design. —Fourteen suction techniques (combinations of device, suction pressure, and suction intermittency) were evaluated sequentially in the trachea of each of 14 in vitro newborn piglets (1 to 4 days old); the order was randomized using a Latin square design. We chose three devices to compare: a meconium aspirator (Neotech Products Inc, Chatsworth, Calif), a hand pump (Res-Q-Vac, Repromed Systems Inc, New York, NY), and a 1OF suction catheter (Superior Healthcare Group Inc, Cumberland, RI). Both the meconium aspirator and the hand pump were used with a 3.0-mm endotracheal tube. Intervention. —We instilled 0.8 mL of a homogeneous mixture of human meconium and saline (44 g of meconium per 100 mL of saline) in the trachea before applying each suction technique. The meconium aspirator and the suction catheter were each evaluated at three different vacuum pressures, -40, -80, and -150 mm Hg, using both continuous and interrupted suction. The hand pump was evaluated with one and two activations (one activation generates -100 cm H2O, according to the manufacturer). Measurements and Results. —The percentage of instilled meconium recovered was consistently greatest (P<.001) with the meconium aspirator (mean, 88.9% at -150 mm Hg, 84.9% at -80 mm Hg, and 73.5% at -40 mm Hg), intermediate with the catheter (mean, 81.0% at -150 mm Hg, 73.2% at -80 mm Hg, and 67.5% at -40 mm Hg), and least for the hand pump (mean, 67.9% with one activation and 72.6% with two activations). Recovery was better with continuous suction (P=.02) and increasing pressure (P<.001). Conclusions. —Among the techniques compared, the meconium aspirator at -150 mm Hg, using continuous suction, performed best in this model. It is unknown, however, to what extent the tracheal mucosa may be affected by this degree of negative pressure.(AJDC. 1992;146:1085-1089) References 1. Holtzman RB, Banzhaf WC, Silver RK, Hageman JR. Perinatal management of meconium staining of the amniotic fluid . Clin Perinatol . 1989;16: 825-851. 2. Burke-Strickland M, Edwards NB. Meconium aspiration in the newborn . Minn Med . (December) 1973;56:1031-1038. 3. Wiswell TE, Tuggle JM, Turner BS. The meconium aspiration syndrome: have we made a difference? Pediatrics . 1990;85:715-721. 4. Gregory GA, Gooding CA, Phibbs RH, Tooley WH. Meconium aspiration in infants: a prospective study . J Pediatr . 1974;85:848-852.Crossref 5. Centers for Disease Control. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other blood borne pathogens in health care settings . MMWR . 1988;37: 377-388. 6. Corraggio MJ, Alexander H, Roscelli J. A meconium suctioning device that is safe and practical . J Perinatol . 1989;9:427-429. 7. Eisner P. Suctioning meconium from the trachea: a new solution to an old problem . Pediatrics . 1986;78:713. 8. Kempen PM. AIDS and suctioning newborn infants . Pediatrics . 1988; 82:520-521. 9. Fazen LE. Modified apparatus for the aspiration of meconium from the airway . Pediatrics . 1982;70:307-308. 10. Pretlow RA. Hand powered apparatus for aspiration of meconium from the airway . Pediatrics . 1987;79:642-643. 11. Beck R. Meconium suctioning . Pediatrics . 1987;80:461. 12. Ballard JL, Farley AF, Atherton H, Musial J, Khoury JC. Negative pressures used for delivery room neonatal resuscitation . J Pediatr . 1988;112: 478-481.Crossref 13. Kirk RE. Experimental Design-Procedures for the Behavioral Science . Belmont, Calif: Brooks/Cole Publishing Co; 1982:308-345. 14. Eisner P. In reply: meconium suctioning . Pediatrics . 1987;80:461. 15. Cropley C, Bloom RS. Texbook of Neonatal Resuscitation . Elk Grove Village, Ill, and Dallas, Tex: American Academy of Pediatrics and the American Heart Association; 1987:2-17-2-18. 16. Kopotic RJ, Day RF, Schellenberg LD, Skoglund JM, Mannino FL. Comparison of devices for rapid removal of airway meconium . Respir Care . 1986;31:976. 17. Sackner MA, Landa JF, Greeneltch N, Robinson MJ. Pathogenesis and prevention of tracheobronchial damage with suction procedures . Chest . 1973;64:284-290.Crossref 18. Jung RC, Gottlieb LS. Comparison of tracheobronchial suction catheters in humans . Chest . 1976;69:179-181.Crossref 19. Brandstater B, Muallem M. Atelectasis following tracheal suction in infants . Anaesthesia . 1969;31:468-473.Crossref
TI - Removing Meconium From Infant Tracheae What Works Best?
JF - American Journal of Diseases of Children
DO - 10.1001/archpedi.1992.02160210087028
DA - 1992-09-01
UR - https://www.deepdyve.com/lp/american-medical-association/removing-meconium-from-infant-tracheae-what-works-best-BAulntXKIm
SP - 1085
EP - 1089
VL - 146
IS - 9
DP - DeepDyve
ER -