Management of meconium aspiration syndrome with Highfrequency oscillatory ventilation

##plugins.themes.academic_pro.article.sidebar##

Published Jul 12, 2011
Download
pdf
Vol. 89 No. 7 (2011): Issue Jul 2011

##plugins.themes.academic_pro.article.main##

Asma Bouziri
Asma Hamdi
Ammar Khaldi
Sarra Bel Hadj
Khaled Menif
Nejla Ben Jaballah

Abstract

Background: High-frequency oscillatory ventilation (HFOV) has been advocated for use to improve lung inflation while potentially decreasing lung injury. There were few data on the early use of HFOV in hypoxemic term neonates.
Aim: To evaluate the effectiveness of HFOV, used as the initial mode of ventilation, in neonates with severe meconium aspiration syndrome (MAS).
Methods: In a tertiary care paediatric intensive care unit, 17 term neonates with severe MAS were managed with HFOV, used as the initial mode of ventilation, and prospectively evaluated. Ventilator settings, blood gases, oxygenation index (OI) and alveolar-arterial oxygen difference (P(A-a)O2) were prospectively recorded during HFOV treatment and compared at the multiple time intervals.
Results: Target ventilation was easily achieved with HFOV.
Initiation of HFOV caused a significant decrease in FIO2, achieved as early as 1 hour (from 0.93 ± 0.11 to 0.78 ± 0.25; p=0.031) and the improvement was sustained during the 1-32 hours period. There were a significant decreases in P (A-a) O2 and OI, repectively, at 4 hours (from 562.5 ± 71.7 to 355.4 ± 206 mm Hg; p=0.03) and 8 hours (from 23.3±17 to 14.6±16.3; p=0.04), that were sustained up to 16 and 40 hours . Three neonates (17.6%) developed pneumothorax on HFOV. One patient required oxygen support at 28 days. No significant others complications associated with HFOV were detected. Sixteen infants (94 %) were successfully weaned from HFOV and 15 (88%) survived to hospital discharge.
Conclusion: Use of HFOV as the initial mode of ventilation in neonates with severe MAS is an effective strategy.

Keywords:

High-frequency ventilation, mechanical ventilation, meconium aspiration, newborn, respiratory insufficiency

##plugins.themes.academic_pro.article.details##

References

  1. Flamant C, Nolent P, Hallalel F, Lardeux C, Chevalier Jy, Renolleau S. Evolution of extracorporeal membrane oxygenation (ECMO) in neonatal acute respiratory failure, fifteen years of experience]. Arch Pediatr 2004; 11: 308-14.
  2. Roy Bj, Rycus P, Conrad Sa, Clark RH. The changing demographics of neonatal extracorporeal membrane oxygenation patients reported to the Extracorporeal Life Support Organization (ELSO) Registry. Pediatrics 2000; 106: 1334-8.
  3. Somme S, Liu DC. News trends in extracorporeal membrane oxygenation in newborn pulmonary diseases. Artif Organs 2001; 25: 633-7.
  4. Carter Jm, Gerstmann Dr, Clark RH. High frequency oscillation and extracorporeal membrane oxygenation for the treatment of acute neonatal respiratory failure. Pediatrics 1990; 85: 159-64.
  5. Clark Rh, Yoder Ba, Sell MS. Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr 1994; 124: 447-54.
  6. Kohlet D, Perlman M, Kirpalani H. High frequency oscillation in the rescue of infants with persistent pulmonary hypertension. Crit. Care Med 1988; 16: 510-16.
  7. Varnholt V, Lasch P, Suske G, Kachel W, Brands W. Highfrequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn. Eur J Pediatr 1992;151: 769-74.
  8. Rojas Ma, Lozano Jm, Rojas MX, et al. Randomized, multicenter trial of conventional ventilation versus high-frequency oscillatory ventilation for the early management of respiratory failure in term or near-term infants in Colombia. J Perinatol 2005; 25: 720-4.
  9. Hamilton Pp, Onayemi A, Smyth JA, et al. Comparison of conventional and high frequency ventilation: oxygenation and lung pathology. J Appl Physiol 1983; 55: 131-8.
  10. De Lemos Ra, Coalson Jj, Gertsmann DR, et al. Ventilatory management of infant baboons with hyaline membrane disease: the use of high frequency ventilation. Pediatr Res 1987; 21: 594_602.
  11. De Lemos Ra, Coalson Jj, De Lemos Ja, King Rj, Clark Rh, Gertsmann DR. Rescue ventilation with high frequency oscillation in premature baboons with hyaline membrane disease. Pediatr Pulmonol 1992; 12: 29-36.
  12. Imai Y, Kawano T, Miyasaka K, Takata M, Imai T, Okuyama K. Inflammatory chemical mediators during conventional ventilation. Am J Respir Crit Care Med 1994; 150: 1550-4.
  13. Mcculloch Pr, Forkert Pg, Froese AB. Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis 1988; 137:1185-92.
  14. Meredith Ks, De Lemos Ra, Coalson JJ, et al. Role of lung injury in the pathogenesis of hyaline membrane disease. J Appl Physiol 1989; 66:2150 - 8.
  15. Delemos Ra, Coalson Jj, Meredith Ks, Gerstmann Dr, Null Dm Jr. A comparison of ventilation strategies fot the use of high frequency oscillatory ventilation in the treatment of hyaline membrane disease. Acta Anaesthesiol Scand 1989; 90 (Suppl) : 102-7.
  16. Jackson Cj, Truog We, Standaert TA, et al. Reduction in lung injury after combined surfactant and high-frequency ventilation. Am J Respir Crit Care Med 1994; 150: 534-9.
  17. Wiswell Te, Foster Nh, Slayter Mv, Hachey WE. Management of a piglet model of the meconium aspiration syndrome with highfrequency or conventional ventilation. Am J Dis Child 1992; 146:1287-93.
  18. Hachey We, Eyal Fg, Curtet- Eyal Nl, Kellum FE. Highfrequency oscillatory ventilation versus conventional ventilation in a piglet model of early meconium aspiration. Crit. Care ed 1998; 26: 556-61.
  19. Huang Qw, Sun B, Gao F, et al. Effects of inhaled nitric oxide and high-frequency ventilation in rabbits with meconium aspiration. Biol Neonate 1999; 76:374-82.
  20. Vankaam Ah, Haitsma Jj, De Jaegere A, Van Aalderen Wm, Kok Jh, Lachmann B. Open lung ventilation improves gas exchange and attenuates secondary lung injury in a piglet model of meconium aspiration. Crit Care Med 2004; 32:443-9.
  21. Calkovska A, Sun B, Curstedt T, Renheim G, Robertson B. Combined effects of high-frequency ventilation and surfactant treatment in experimental meconium aspiration syndrome. Acta Anaesthesiol. Scand 1999; 43: 135-45.
  22. Kinsella Jp, Trug We, Walsh WF, et al. Randomized, multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe, persistent pulmonary hypertension of the newborn. J Pediatr 1997; 131(1 Pt 1):55-62.
  23. Kinsella Jp, Abman SH. Inhaled nitric oxide and high frequency oscillatory ventilation in persistent pulmonary hypertension of the newborn. Eur. J. Pediatr. 1998; 157 Suppl1: S28-30.
  24. Wiswell TE. Advances in the treatment of the meconium aspiration syndrome. Acta. Paediatr 2001; 436 Suppl:28-30.
  25. Dargaville Pa, Copnell B, Australian and New Zealand Neonatal Network. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006; 117: 1712-21.
  26. Nolent P, Hallalel F, Chevalier Jy, Flamant C, Renolleau S. Meconium aspiration syndrome requiring mechanical ventilation: incidence and respiratory management in France (2000-2001). Arch. Pediatr 2004; 11: 417-22.
  27. findlay Rd, Taeusch Hw, Walther FJ. Surfactant replacement therapy for meconium aspiration syndrome. Pediatrics1996; 97:48-52.
  28. Lotze A, Mitchell Br, Bulas Di, Zola Em, Shalwitz Ra, Gunkel JH. Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure. Survanta in Term Infants Study Group. J Pediatr 1998; 132: 40-7.
  29. Wiswell Te, Knight Gr, Finner NN, et al. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics 2002; 109:1081-7.