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Am J Perinatol 2011; 28(4): 305-314
DOI: 10.1055/s-0030-1268715
© Thieme Medical Publishers

Bedside Lung Mechanics Predict Survival in Hypoplastic Lung Disease

Abdul Haleem1 , Muhammad T. Zia1 , Ravi Mishra1 , Lance A. Parton1 , Gustavo Stringel2 , Edmund F. La Gamma1
  • 1Division of Newborn Medicine, Department of Pediatrics, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York
  • 2Division of Pediatric Surgery, Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York
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Publication History

Publication Date:
29 November 2010 (online)

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ABSTRACT

Newer bedside pulmonary mechanics using conventional ventilators allow for continuous serial determinations of tidal volume (VT). We sought to determine whether the degree of pulmonary hypoplasia could be measured using bedside pulmonary graphics and whether survival could be predicted in potential extracorporeal membrane oxygenation (ECMO) candidates. Data on all neonates considered for or treated with ECMO at our center between April 2000 and March 2005 were collected. The “maximal bedside VT” was measured daily at the peak pressure where “beaking” began with a peak end expiratory pressure of 4 cm H2O. Twenty-two patients were reviewed: eight ECMO plus fourteen similar patients in whom the threshold for ECMO intervention was not achieved. Independent of need for ECMO, any patient with VT of < 3 mL/kg or < 0.2 mL/cm length died (n = 4). All other measures of lung capacity or blood gas assessments were less valuable than VT in predicting survival. We conclude that bedside VT can be easily measured and that values < 3 mL/kg or < 0.2 mL/cm length demarcate severe lung hypoplasia, which in our patient population was incompatible with survival. We speculate that bedside VT may assist in evaluating the utility of ECMO.

KEYWORDS

Hypoplasia - lung - ECMO - CDH

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Lance A PartonM.D. 

Division of Newborn Medicine, Department of Pediatrics, Maria Fareri Children's Hospital, Westchester Medical Center

New York Medical College, Valhalla, NY 10595

Email: Lance_Parton@nymc.edu

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