[High frequency oscillation in meconium aspiration and bronchopulmonary dysplasia].
Within one year 3 newborns with meconium-aspiration and 4 infants with bronchopulmonary dysplasia (BPD) were treated with HFP, synchronous with conventional ventilation (CMV). The entrance criteria were insufficient oxygenation (PO2/FiO2 < 50 mmHg) and/or CO2-elimination (> 60 mmHg), respectively peak inspiratory pressure Pi > 40 mmHg and mean airway pressure MAP > 20 mbar during CMV. All three cases of meconium-aspiration have shown a striking improvement in oxygenation and ventilation, in one case starting from a disastrous situation with PCO2 > 90 mmHg, PO2 30 mmHg (FiO2 100%). After a HFO period of 9 to 10 hours Pi, MAP and CMV-frequency could be reduced. The patients could be extubated after 1-2 weeks. In severe BPD only in one case continuous improvement and extubation in the 4. week of life were possible. Here the pulmonary artery pressure in doppler-echocardiography slightly was elevated (30-35 mmHg). In a further case extubation was possible after several trials with HFO. Indeed chronic respiratory insufficiency, progredient pulmonary emphysema on x-ray and clearly elevated pulmonary artery pressure (> 40 mmHg) persisted. In 2 further cases there was no longstanding improvement of ventilation. One child died after 8 months, one after 6 months. In both cases there was a right-to-left shunt over foramen ovale and pulmonary artery pressures at systemic level. HFO led to an improvement in oxygenation and ventilation in all three cases of meconium-aspiration and probably prevented a fatal outcome in one case. The effect seems to depend on improved secretolysis and gas exchange.(ABSTRACT TRUNCATED AT 250 WORDS)
Herterich
R
R
Kinderklinik St. Marien Landshut.
Fackeldey
E
E
Hofweber
K
K
Steck
W
W
Neumaier
F
F
Arends
H
H
D001997:Bronchopulmonary Dysplasia / Q000503:physiopathology / Q000628:therapy*; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006612:High-Frequency Ventilation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000503:physiopathology / Q000628:therapy*; D010100:Oxygen / Q000097:blood
D002245:Carbon Dioxide; D010100:Oxygen
Hochfrequenzoszillation (HFO) bei Mekoniumaspiration und bei Bronchopulmonaler Dysplasie.