High-frequency oscillation and paralysis stabilize surfactant protein-B--deficient infants.
OBJECTIVE
To determine if high-frequency oscillatory ventilation and neuromuscular blockade improve oxygenation and chest radiographic appearance more effectively than high-frequency oscillation alone for surfactant protein-B (SP-B)--deficient infants.


METHODS
We reviewed medical records and chest radiographs of five SP-B--deficient infants awaiting lung transplantation. Changes in FiO2 and radiographic scores were analyzed with respect to neuromuscular blockade status.


RESULTS
FiO2 consistently increased 0.20 (SD 0.11) during high-frequency ventilation without neuromuscular blockade (p = 0.02) and decreased 0.14 (SD 0.11) during high-frequency ventilation with neuromuscular blockade (p = 0.05). Chest radiographic appearance, quantified by an expansion/aeration index, consistently deteriorated without neuromuscular blockade (p = 0.01) and consistently improved with neuromuscular blockade (p = 0.03). Changes in FiO2 correlated with changes in radiograph scores (r = 0.7, p < 0.001).


CONCLUSIONS
High-frequency ventilation with neuromuscular blockade optimizes oxygenation for SP-B--deficient infants. This ventilatory strategy should be considered while awaiting the diagnosis of SP-B deficiency or lung transplantation.
King
E L
EL
Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA.
Shackelford
G D
GD
Hamvas
A
A
D003677:Deficiency Diseases / Q000151:congenital* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019148:Neuromuscular Blockade; D011510:Proteolipids; D011659:Pulmonary Gas Exchange / Q000502:physiology; D011663:Pulmonary Surfactants / Q000172:deficiency*; D012131:Respiratory Insufficiency / Q000151:congenital* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies
D011510:Proteolipids; D011663:Pulmonary Surfactants