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Idiopathic pulmonary hemorrhage in infancy. Clinical features and management with high frequency ventilation
M D Pappas1, A P Sarnaik, K L Meert
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA.
Insights
Severe acute pulmonary hemorrhage in infants is dangerous but treatable. High-frequency ventilation (HFV) effectively improved gas exchange and oxygenation in infants with this condition, leading to survival without complications.
Area of Science:
- Pediatric Critical Care Medicine
- Neonatology
- Respiratory Physiology
Background:
- Severe acute pulmonary hemorrhage is a critical condition in infants.
- Idiopathic pulmonary hemorrhage presents a significant risk to infant life, particularly in urban settings.
- Understanding the clinical characteristics and effective management strategies is crucial.
Purpose of the Study:
- To detail the clinical features of infants experiencing severe acute pulmonary hemorrhage.
- To evaluate the impact of mechanical ventilation, specifically high-frequency ventilation (HFV), on gas exchange in these infants.
Main Methods:
- A retrospective review of case records for infants diagnosed with severe acute pulmonary hemorrhage between January 1992 and July 1995.
- Definition of acute pulmonary hemorrhage included hemoptysis, epistaxis, or endotracheal blood without identifiable cardiac, vascular, infectious, or traumatic causes.
- Patients initially received conventional ventilation, transitioning to high-frequency ventilation (HFV) for persistent hypoxemia or respiratory acidosis.
Main Results:
- Six male infants presented with severe acute pulmonary hemorrhage, with a median age of 2.3 months.
- Chest radiographs revealed diffuse bilateral infiltrates; all infants were managed with HFV (oscillation or jet).
- HFV led to improved pH and PaCO2, reduced oxygen requirements, and a trend toward better oxygenation within 6-24 hours; all infants survived without complications.
Conclusions:
- Idiopathic acute pulmonary hemorrhage is a life-threatening condition in inner-city infants.
- High-frequency ventilation (HFV) demonstrates high effectiveness and safety.
- HFV rapidly reverses severe oxygenation and ventilation deficits in infants with pulmonary hemorrhage.
Study Objectives:
To describe the clinical characteristics of infants with severe acute pulmonary hemorrhage and the effects of mechanical ventilation on gas exchange.
Setting:
Tertiary care pediatric ICU in a university hospital.
Patients And Design:
Case records of patients with severe acute pulmonary hemorrhage from January 1992 to July 1995 were reviewed. Acute pulmonary hemorrhage was defined as hemoptysis and/or epistaxis or blood obtained from endotracheal tube which could not be attributed to cardiac or vascular malformation, infectious process, or known trauma.
Interventions:
Patients were initially managed with conventional ventilation. High frequency ventilation (HFV) was utilized when hypoxemia (PaO2/PAO2 < 0.2) and/or respiratory acidosis (PaCO2 > or = 60 mm Hg with pH < 7.25) persisted.
Measurements And Results:
Six African-American male infants from Detroit, with a median age 2.3 months, presented with severe acute pulmonary hemorrhage. Chest radiographs showed diffuse bilateral infiltrates or opacification with a normal sized heart. All infants were managed with HFV, four by oscillation and two by jet. The indications for HFV were persistent hypoxemia (2), respiratory acidosis (1), and a combination of both (3). There was an improvement in pH and PaCO2, and a decreased need for oxygen 6 and 24 h after initiating HFV. PaO2/PAO2 and oxygenation index showed a tendency toward improvement. All infants survived, and there were no complications. No cause for pulmonary hemorrhage was found in any of the infants.
Conclusions:
Idiopathic acute pulmonary hemorrhage is a potentially life-threatening disorder encountered among inner-city infants. HFV is highly effective and safe in rapidly reversing the severe oxygenation and ventilation deficits in this setting.