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Management of infants with severe respiratory failure and persistence of the fetal circulation, without

J T Wung, L S James, E Kilchevsky

    Pediatrics
    |October 1, 1985
    PubMed

    Insights

    This study presents a successful management strategy for infants with persistent pulmonary hypertension of the newborn (PPHN) and severe respiratory failure, minimizing ventilator-induced lung injury. All infants survived, highlighting the effectiveness of this low-pressure ventilation approach.

    Area of Science:

    • Neonatal Medicine
    • Pediatric Pulmonology
    • Critical Care

    Background:

    • Persistent pulmonary hypertension of the newborn (PPHN) is a critical condition causing severe respiratory failure in infants.
    • Minimizing barotrauma during mechanical ventilation is crucial for managing these vulnerable patients.

    Purpose of the Study:

    • To describe a successful treatment regimen for infants with PPHN and severe respiratory failure.
    • To evaluate the efficacy of a ventilation strategy focused on minimizing barotrauma.

    Main Methods:

    • Nasotracheal intubation and intermittent mandatory ventilation (IMV) were employed.
    • Peak inspiratory pressures were guided by chest excursion; permissive hypercapnia was utilized (PaCO2 up to 60 mm Hg).
    • Tolazoline and dopamine were administered as adjunctive therapies.

    Main Results:

    • All 15 infants survived the acute phase.
    • Ten infants showed improved oxygenation with tolazoline.
    • Only one infant developed chronic lung disease.

    Conclusions:

    • A management strategy focused on minimizing barotrauma, utilizing permissive hypercapnia, and appropriate pharmacotherapy can lead to successful outcomes in PPHN.
    • This approach demonstrates the potential for high survival rates and reduced chronic lung disease in neonates with severe respiratory failure.

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