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[High frequency oscillation in meconium aspiration and bronchopulmonary dysplasia]
R Herterich1, E Fackeldey, K Hofweber
1Kinderklinik St. Marien Landshut.
Insights
High-frequency oscillatory ventilation (HFOV) improved oxygenation and ventilation in newborns with meconium aspiration syndrome. HFOV also showed benefits in some infants with bronchopulmonary dysplasia (BPD), aiding extubation.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Context:
- Neonatal respiratory distress is a significant challenge.
- Meconium aspiration syndrome and bronchopulmonary dysplasia (BPD) are severe conditions requiring advanced respiratory support.
- Conventional mechanical ventilation (CMV) may be insufficient in critical cases.
Purpose:
- To evaluate the efficacy of high-frequency oscillatory ventilation (HFOV) in newborns with meconium aspiration syndrome and BPD.
- To assess HFOV's impact on oxygenation, ventilation, and extubation success.
- To compare HFOV outcomes with conventional ventilation (CMV) parameters.
Summary:
- HFOV was administered to 3 newborns with meconium aspiration and 4 infants with BPD.
- All meconium aspiration cases showed improved oxygenation and ventilation, with one severe case improving dramatically.
- In severe BPD, HFOV facilitated extubation in 2 out of 4 cases, with one showing continuous improvement.
Impact:
- HFOV improved oxygenation and ventilation in all meconium aspiration cases, potentially preventing fatal outcomes.
- HFOV facilitated extubation in some infants with severe BPD, though chronic respiratory insufficiency persisted in some.
- The mechanism of HFOV's benefit may involve enhanced secretolysis and gas exchange.
Abstract:
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)