Extracorporeal membrane oxygenation and high-frequency oscillatory ventilation

Cornish, J. Devn; Gerstmann, Dale R.; Clark, Reese H.; Carter, Jan; Null, Donald M.; deLemos, Robert A.

doi:10.1097/00003246-198709000-00006

Cited by 53 publications

(17 citation statements)

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“…This is in line with the results of others [5,8], who also stressed that children of younger gestational age [5], with higher Apgar scores [8], less extensive hypoxaemia [5] and lower pCO2 during conventional respirator therapy [5] seemed to respond more favourably to HFOV. In contrast, in another study [15] nearly all patients (37 out of 41 with 34 survivors) responded to HFOV.…”

Section: Discussionsupporting

confidence: 91%

High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn

et al. 1992

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We report on 50 term and near-term neonates (birth weight greater than 1800 g, gestational age greater than 33 weeks) with severe persistent pulmonary hypertension of the newborn (PPHN), referred to us from January 1987 to July 1991 after failure of maximum conventional treatment. All infants had paO2 less than 45 mm Hg when ventilated with peak inspiratory pressure greater than 38 cm H2O and FiO2 = 1.0, hence meeting entry criteria for extracorporeal membrane oxygenation (ECMO). High frequency oscillatory ventilation (HFOV) was tried in all patients. If sufficient oxygenation could not be achieved (paO2 less than 40 mm Hg for at least 2 h), ECMO therapy was begun, which was the case in 25 children. Neonates responding to HFOV (n = 25) were of a slightly younger gestational age (37.0 weeks vs 38.8 weeks, P less than 0.05), had higher Apgar scores and were less hypoxaemic before HFOV (paO2 36.6 mm Hg vs 28.8 mm Hg, P less than 0.01); during HFOV there was a significant rise in paO2 (greater than 150 mm Hg; P less than 0.001) and a fall in pCO2 to 21.6 mm Hg (P less than 0.001). Due to air leaks, which was the main complication of HFOV (52%), ECMO therapy had to be begun in two additional infants after an initial positive effect. HFOV tended to be successful in cases of primary PPHN, meconium aspiration and sepsis, but not in infants with lung hypoplasia as a result of diaphragmatic hernia or other reasons. Success or failure of HFOV could not be reliably predicted by any parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionsupporting

confidence: 91%

High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn

et al. 1992

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“…Infants with PPHN from a variety of causes have been successfully treated with high frequency ventilation of the oscillatory (283)(284)(285) or jet ventilation types (286). High frequency ventilation decreases Paco 2 , and in the case of the oscillator, increases oxygenation in infants with PPHN (225,283,284,286).…”

Section: Management Of Pphn Correction Of Alveolar Hypoxia/hypercarbiamentioning

confidence: 99%

“…High frequency ventilation decreases Paco 2 , and in the case of the oscillator, increases oxygenation in infants with PPHN (225,283,284,286). The oscillatory type of high frequency ventilation appears to improve oxygenation through the use of higher mean airway pressures to maintain lung volume and prevent atelectasis.…”

Section: Management Of Pphn Correction Of Alveolar Hypoxia/hypercarbiamentioning

confidence: 99%

Persistent pulmonary hypertension of the newborn.

Morin¹,

Stenmark²

1995

Am J Respir Crit Care Med

131

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“…During high frequency jet ventilation, the oxygenation index and mean airway pressure should be monitored serially, since they may predict the need for extracorporeal membrane oxygenation. Eur Respir J., 1996Respir J., , 9, 1257 Recent reports have shown that infants with severe respiratory failure unresponsive to conventional therapies and meeting the traditional qualifying criteria for extracorporeal membrane oxygenation (ECMO) may respond when placed on high frequency ventilation without requiring ECMO [1][2][3]. BAUMGART et al [3] demonstrated that infants in intractable respiratory failure who are candidates for ECMO can sometimes be rescued by high frequency jet ventilation (HFJV) if a rapid decrease in the oxygenation index (OI) is seen at 1 and 6 h after the initiation of HFJV, thus avoiding ECMO.…”

mentioning

confidence: 99%

Response to high frequency jet ventilation may predict the need for extracorporeal membrane oxygenation

Cruz²,

Duncan³

et al. 1996

Eur Respir J

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The aim of this study was to determine predictors of response whilst using high frequency jet ventilation (HFJV) for infants in intractable respiratory failure, in order to avoid the utilization of extracorporeal membrane oxygenation (ECMO). We reviewed patient demographics, ventilator parameters, blood gas values, length of oxygen therapy and use of surfactant and outcome, in infants given a 4 h trial of HFJV as the minimum to eliminate those infants where HFJV is used as a bridge to ECMO. The study was carried out in the neonatal intensive care nursery at Kosair Children's Hospital in Louisville, Kentucky, which provides high frequency ventilation and ECMO. Thirty infants who were eligible for ECMO and who met the study criteria were divided into two groups based upon response to HFJV. Twenty two infants responded to HFJV and eight nonresponders required ECMO after a trial of HFJV. Infants responding during HFJV demonstrated a significant decrease in oxygenation index without an escalation of mean airway pressure within 4 h after the initiation of HFJV. These infants had lower birth weights and an increased incidence of respiratory distress syndrome. No statistical differences were found in length of ventilation, days of oxygen therapy or duration of HFJV between the groups. Infants in intractable respiratory failure, who are eligible for extracorporeal membrane oxygenation, should receive a trial of high frequency jet ventilation, especially if the cause is respiratory distress syndrome unresponsive to surfactant therapy. During high frequency jet ventilation, the oxygenation index and mean airway pressure should be monitored serially, since they may predict the need for extracorporeal membrane oxygenation.

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Extracorporeal membrane oxygenation and high-frequency oscillatory ventilation

Cited by 53 publications

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High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn

High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn

Persistent pulmonary hypertension of the newborn.

Response to high frequency jet ventilation may predict the need for extracorporeal membrane oxygenation

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