High-Frequency Ventilation in the Management of Very-Low-Birth-Weight Infants with Pulmonary Hemorrhage

Severe hypoxic respiratory failure secondary to massive pulmonary hemorrhage (MPH) in preterm infants could be fatal. The aim of this study was to assess the efficacy of high-frequency ventilation (HFV) as a rescue therapy for respiratory failure secondary to MPH in very-low-birth-weight (VLBW) infants. Prospectively we followed up all VLBW infants with pulmonary hemorrhage between January 1993 and December 1996 in our neonatal intensive care unit at King Khalid University Hospital. Seventeen VLBW infants with severe hypoxic respiratory failure secondary to MPH were treated with HFV. Ten (59%) infants responded to HFV and survived, while the other 7 (41%) did not respond and expired. Patent ductus arteriosus was considered the most common associated condition in 10 infants (59%). There were no statistically significant differences between the responders and the nonresponders in regard to gestational age, birth weight, sex ratio, % inborn, and primary diagnosis. However, preintervention peak inspiratory pressure (pip), arterial-alveolar ratio (a/A ratio) and oxygenation index (OI) were higher in the nonresponders (p = 0.02, p = 0.03, and p = 0.003, respectively), while pip, FIO ₂, paCO ₂, a/A ratio and OI were significantly lower than the nonresponders 3 hours postintervention (p = 0.008, p = 0.006, p = 0.0002, p = 0.0005, and p = 0.0007, respectively). In conclusion, HFV might be an effective and lifesaving mode of treatment in VLBW infants with respiratory failure secondary to MPH; therefore, prospective randomized controlled trials are needed to confirm these findings.

HFV - VLBW infants - pulmonary hemorrhage - respiratory failure

REFERENCES

• 1 Braun K R, Davidson K M, Henry M et al.. Severe pulmonary hemorrhage in the premature newborn infant: analysis of pre-surfactant and surfactant eras.  Biol Neonate. 1999;  75 18-30
• 2 Coffin C M, Schechtman K, Cole F S et al.. Neonatal and infantile pulmonary hemorrhage an autopsy study with clinical correlation.  Pediatr Pathol. 1993;  13 583-589
• 3 Van Houten J, Long W, Mullet M et al.. Pulmonary hemorrhage in premature infants after treatment with synthetic surfactant an autopsy evaluation.  J Pediatr. 1992;  120 S40-S44
• 4 Clark R H, Gerstmann D R, Null D M et al.. Pulmonary interstitial emphysema treated by high-frequency oscillatory ventilation.  Crit Care Med. 1986;  14 926-930
• 5 Carlo W A, Beoglos A, Chatburn R L, Walsh M C, Martin R J. High-frequency jet ventilation in neonatal pulmonary hypertension.  Am J Dis Child. 1989;  143 233-238
• 6 Keszler M, Donn S M, Bucciarelli R L et al.. Multicenter controlled trail comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema.  J Pediatr. 1991;  119 85-93
• 7 Clark R H, Gerstmann D R, Null D M et al.. Prospective randomised comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome.  Pediatrics. 1992;  89 5-12
• 8 Ogawa Y, Miyasaka K, Kawano T et al.. A multicenter randomised trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure.  Early Hum Dev. 1993;  32 1-10
• 9 HiFO Study Group .Randomised study of high-frequency oscillatory ventilation in infants with severe respiratory distress syndrome. J Pediatr. 1993 122: 609-619
• 10 Clark R H, Bradley A, Yoder B A et al.. Prospective, randomised comparison of high-frequency oscillation and conventional ventilation in candidates for extra corporeal membrane oxygenation.  J Pediatr. 1994;  124 447-454
• 11 Keszler M, Modanlou H D, Brudno S et al.. Multicenter controlled clinical trial of high-frequency jet ventilation in preterm infants with uncomplicated respiratory distress syndrome.  Pediatrics. 1997;  100 593-599
• 12 Gerstmann D R, Minton S D, Stoddard R A et al.. The provo multicenter early high-frequency oscillatory ventilation trail: improved pulmonary and clinical outcome in respiratory distress syndrome.  Pediatrics. 1996;  98 1044-1057
• 13 Jackson J C, Truog W E, Standaert T A et al.. Reduction in lung injury after combined surfactant and high-frequency ventilation.  Am J Respir Crit Care Med. 1994;  150 534-539
• 14 Clark R H, Dykes F D, Bachmann T E, Ashurst J T. Intraventricular hemorrhage and high-frequency ventilation: a meta-analysis of prospective clinical trials.  Pediatrics. 1996;  98 1058-1061
• 15 Boynton B R, Mannino F L, Davis R F, Kopotic R J, Friederichsen G. Combined high-frequency oscillatory ventilation and intermittent mandatory ventilation in critically ill neonates.  J Pediatr. 1984;  105 297-302
• 16 Murthy B VS, Petros A J. High-frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates and infants.  Acta Anaesthesiol Scand. 1996;  40 679-683
• 17 Walther F J, Kuipers I M, Gidding C EM et al.. A comparison of high-frequency oscillation superimposed onto backup mechanical ventilation and conventional mechanical ventilation on the distribution of exogenous surfactant in premature lambs.  Pediatr Res. 1987;  22 725-729
• 18 Rudolph A J, Smith C A. Idiopathic respiratory distress syndrome of the newborn.  J Pediatr. 1960;  57 905-921
• 19 HiFI Study Group .High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in pre-term infants. N Engl J Med. 1989 320: 88-93
• 20 Papile L A, Burstein J, Burstein R, Koffler H. Evaluation of subependymal and intraventricular hemorrhage.  J Pediatr. 1978;  92 529-534
• 21 Committee for the Classification of Retinopathy of Prematurity . The international classification of retinopathy of prematurity.  Br J Ophthalmology. 1984;  68 690-697
• 22 Duval E L, Mark horst D G, Geake R J et al.. High-frequency oscillatory ventilation in pediatric patients.  Net J Med. 2000;  56 177-185
• 23 McCulloch P R, Forcer P G, Faroese A B et al.. Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficiency rabbits.  Am Rev Respir Dis. 1988;  137 1185-1192
• 24 Bond D M, Faroese A B. Volume recruitment manoeuvres are less deleterious than persistent low lung volumes in the atelectasis-prone rabbit lung during high-frequency oscillation.  Crit Care Med. 1993;  21 402-412
• 25 Bond D M, McAloon J, Froese A B. Sustained inflations improve respiratory compliance during high-frequency oscillatory ventilation but not during large tidal volume positive-pressure ventilation in rabbits.  Crit Care Med. 1994;  22 1269-1277
• 26 Blum-Hoffmann E, Kopotic R J, Mannino F L. High-frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates: 3 years of experience.  Eur J Pediatr. 1988;  147 392-398
• 27 Ko S Y, Chang Y S, Park W S et al.. Massive pulmonary hemorrhage in newborn infants successfully treated with high frequency oscillatory ventilation.  J Korean Med Sci. 1998;  13 495-499
• 28 Baden H P, Li C M, Hall D et al.. High-frequency oscillatory ventilation in the management of infants with pulmonary hemorrhage after cardiac surgery.  J Cardiothorac Vasc Anesth. 1995;  9 578-580
• 29 Pappas M D, Sarnaik A P, Meert K L et al.. Idiopathic pulmonary hemorrhage in infancy. Clinical features and management with high frequency ventilation.  Chest. 1996;  110 553-555
• 30 Long W, Corbet A, Allen A et al.. Retrospective search for bleeding diathesis among premature newborn infants with pulmonary hemorrhage after synthetic surfactant. The American Exosurf Neonatal study group I, and the Canadian Exosurf Neonatal study group.  J Pediatr. 1992;  120 S45-S48