Modern treatment modalities for neonatal and pediatric respiratory failure.
BACKGROUND
Respiratory failure secondary to a variety of causes remains a significant cause of morbidity and mortality in the pediatric population. Newer therapies are appearing frequently in an attempt to decrease the number of deaths from this disease state. We briefly review the current literature on some of the newer modalities including: high-frequency ventilation, surfactant, liquid ventilation, and nitric oxide. We then present our experience from the past 11 years in the most invasive, yet successful, therapy for acute respiratory failure-extracorporeal membrane oxygenation (ECMO).


METHODS
Retrospective review of all patients treated with ECMO from September 1983 to December 1994 was undertaken. Data were collected from bedside ECMO flow sheets and the standardized data entry forms submitted to the Extracorporeal Life Support Organization. All statistical analyses were performed using a standard statistical software program.


RESULTS
During the study period, 194 neonates and 47 pediatric patients were treated with ECMO. The survival rate in the neonatal population is 82% and in the pediatric population it is 40%. The neonatal patients required an average of 153 hours of support while the pediatric patients required 220 hours (P = 0.008).


CONCLUSIONS
While the newer treatment modalities discussed may have an important role in treating neonatal and pediatric respiratory failure in the near future, ECMO remains a cornerstone of the modern treatment modalities. Although somewhat invasive, ECMO is effective therapy with increasing survival rates each year.
Arensman
R M
RM
Department of Surgery and Pediatrics, University of Chicago, Wyler Children's Hospital, Illinois 60637, USA.
Statter
M B
MB
Bastawrous
A L
AL
Madonna
M B
MB
D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D011663:Pulmonary Surfactants; D009569:Nitric Oxide