High-frequency oscillatory ventilation (HFOV) in the treatment of neonatal respiratory disturbances: case reports of two infants.
The technique of high-frequency oscillatory ventilation (HFOV) was successfully used in a preterm infant with severe hyaline membrane disease and in a term neonate presenting with intrauterine pneumonia and associated severe pneumomediastinum. None of the infants could adequately be ventilated by conventional ventilation; both of them deteriorated owing to severe hypoxaemia and hypercapnia. In the preterm infant with HMD a rapid and progressive improvement of oxygenation had been observed immediately after the beginning of HFOV, and he was successfully weaned off the ventilator after 71 hours on HFOV. His recovery was uncomplicated and definitive. In the term neonate presenting with IUP and associated severe PM, an improvement in oxygenation was detected, whereas the retention of paCO2 remained unaltered. On leaving the MAP unchanged but doubling the flow rate, paCO2 and arterial pH also normalised. No sign of PM was seen on the X-ray picture 17.5 hours after the start of HFOV. This patient was weaned off the ventilator after 29 hours on HFOV and his recovery was also uncomplicated. It is believed that recovery of the PM was secondary to the low MAP and to the higher arterial pO2 levels, and that HFOV may also have a direct role in the treatment of preexisting air leaks and perhaps also in their prevention. In our patients HFOV resulted in a definitive recovery, while no improvement had occurred on using conventional ventilation. To determine the exact mechanism of action, the clear cut fields of indications and the possible side effects of HFOV, further investigations are needed.
D002245:Carbon Dioxide / Q000097:blood; D006801:Humans; D006813:Humidity; D006819:Hyaline Membrane Disease / Q000097:blood / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications / Q000151:congenital; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000150:complications / Q000151:congenital; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000209:etiology / Q000628:therapy*; D013696:Temperature; D014043:Tolazoline / Q000008:administration & dosage
D002245:Carbon Dioxide; D014043:Tolazoline; D010100:Oxygen