Innovative Therapies for Neonatal Respiratory Failure: High-Frequency Ventilation and Extracorporeal Membrane Oxygenation

Bui, Kevin; Cornish, J. Devn

doi:10.1055/s-2007-1006198

Cited by 2 publications

(2 citation statements)

References 92 publications

(150 reference statements)

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“…A possible reason is low pCO2-value (necessary for overcoming PPHN), resulting in decreased cerebral blood flow and increased vulnerability of blood vessels [4]. Bleeding complications other than ICH under ECMO were of minor importance and did not influence our mortality rate.…”

Section: Brain Infarction (N)mentioning

confidence: 85%

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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: Brain Infarction (N)mentioning

confidence: 85%

“…The latter include high frequency oscillatory ventilation (HFOV) [15], which was first used in neonates about 12-15 years ago [16]. However, HFOV is -like ECMO -still considered an experimental therapy [4].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 1992

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High-Frequency Oscillatory Ventilation and Nitric Oxide: Alternative or Complementary to ECMO

Kachel

Varnholt²,

Müller³

et al. 1995

Int J Artif Organs

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One hundred and seventy-seven term or near-term neonates were referred to an ECMO center for severe PPHN-associated diseases. In 2 time periods from 1987 to 1991 and from 1992 to April 1995 alternative treatment modes were tried in an attempt to obviate ECMO. During the first time period patients underwent trial high-frequency oscillatory ventilation before ECMO. In the second time period patients first received inhaled NO followed by HFOV in a non-responders. If this also failed HFOV was combined with INO. In both time periods about 40% of the patients were spared ECMO treatment by these alternative treatment modalities. INO only benefited 15% of the ECMO candidates who apparently had fared just as well on HFOV alone in the preceding time period. While patients who were improved by INO were spared HFOV with its potential severe complications, i.e. air leaks and cardiocirculatory instability, more extended long-term studies will have to show which of these 2 treatment modalities (INO or HFOV) should be given first priority in an attempt to avoid ECMO in neonates with severe respiratory failure.

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Innovative Therapies for Neonatal Respiratory Failure: High-Frequency Ventilation and Extracorporeal Membrane Oxygenation

Cited by 2 publications

References 92 publications

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

High-Frequency Oscillatory Ventilation and Nitric Oxide: Alternative or Complementary to ECMO

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